【作者】 高航；

【导师】 刘建国；

【作者基本信息】 吉林大学 ， 临床医学， 2010， 硕士

【摘要】 胫骨平台骨折是常见的关节内骨折,常见于高能量创伤的青中年人及轻微创伤后的老年人。关节僵硬、膝关节疼痛、创伤性关节炎、关节不稳等为其常见的并发症。临床上常用Schatzker分型,其中Ⅳ型骨折累及内侧平台,可表现为单纯胫骨内髁劈裂骨折或内侧平台塌陷骨折(常可合并髁间隆起骨折)。目前普遍认为:胫骨平台骨折多影响胫股关节面的完整性,关节内解剖复位、支撑内固定、充分植骨、恢复术后早期活动、晚期负重,是手术成功的必要保证。胫骨平台内侧骨折(Schatzker分型,Ⅳ型)的手术要点也是如此,但因内侧平台骨块是双髁平台骨折中最不稳定的部分,控制其移位的能力往往是反映某一固定方法力学性能的重要指标。拉力螺钉、解剖钢板及锁定钢板是治疗这一类型骨折的常用方法,但拉力螺钉及解剖钢板的制控性差,文献报道术后高度丢失明显,因此锁定钢板在治疗中的作用日显优越。本文通过对我院2003年—2009年间SchatzkerⅣ型胫骨平台骨折行切开复位内固定术的患者进行随访,取得完整随访资料的26例,按照内固定物的不同分成LCP组16例和解剖型支持钢板组10例。临床疗效评价应用HSS膝关节功能评分,影像学评价Rasmussen胫骨平台骨折复位解剖学评分标准。术后LCP组HSS评分平均提高到84.9分,优良率75%,而解剖型支持钢板组平均提高到74.8分,优良率50%。LCP组术后影像学评分优良率(81.2%)也高于解剖型支持钢板组(50%)。经统计学软件采用四格表Fisher精确概率法分析,P<0.05,具有统计学意义。同时分别比较切口感染、高度丢失、膝内外翻畸形、创伤性关节炎等术后并发症的发病率,锁定加压钢板组治疗效果也优于解剖型支持钢板组。对比国内外文献报道,认为锁定钢板内固定可以为SchatzkerⅣ型胫骨平台骨折提供持续、可靠的固定,能有效地防止骨折再移位和膝关节力线的改变,临床疗效满意。更多还原

【Abstract】 Objective: To summarize the current SchatzkerⅣtibial plateau fracture of the various treatment methods, analysis of its efficacy, and compare our results with domestic and abroad reports. Eventrually compare the clinical outcome of locking compression plate and anatomic butress plate in fixation of tibial SchatzkerⅣplateau fracture.Methods: 42 patients with SchatzkerⅣtibial plateau fracture were treated with open reduction and internal fixation between January 2003 ~ January 2009 at our hospital. Complete follow-up data of 26 patients were obtained. The patients average age were 36.3 years. According to the different internal fixation, these patients were divided into locking compression plate fixation group(16 cases) and anatomic butress plate group(10 cases). Follow-up period was 1 to 7 years with average follow-up time 2.2 years. Clinical Evaluation was through application of HSS knee score, radiographic evaluation of tibial plateau fractures and Rasmussen anatomical scoring.Statistical software SPSS17.0 were used to analyze the patients HSS knee score, Rasmussen excellent rate of imaging. compare the clinical outcome of locking compression plate and anatomic butress plate in fixation of tibial SchatzkerⅣplateau fracture.Results: According to the reference standard of HSS knee score, the Average in LCP group was 79.9 and there were 7 cases with excellent results, good in 5 cases, fair in 4 cases, and the excellent rate was 75%. 2 cases with excellent results in anatomical support plate group, good in 3 cases, fair in 4 cases and poor in 1 case, Average was 71.8and excellent rate was 50%; Imaging evaluation of tibial plateau fractures was through Rasmussen scoring anatomy, LCP group were excellent in 7 cases, good in 6 cases, fair in 3 cases, good rate was 81.2%. Butress plates group were excellent in 2 cases, good in 3 cases, fair in 4cases and poor in 1 case , the good rate was 50%.The above data was analyzed by four tables from Fisher test and the results showed two kinds of internal fixation treatment of SchatzkerⅣtibial plateau fracture fine had significant difference (P < 0.05), meanwhile locking compression plate group did better than the anatomical support plate group in wound infection, a high degree of loss, knee varus deformity, traumatic joint the incidence of postoperative complications so far.Conclusion:(1)LCP afford a stable and durable fixation to avoid the replacement and change of the knee mechanics. Combining bone transplantation, it achieve reliable effect.(2)Anatomical reduction, positively remedy injury of ligament and meniscus probably prevent complications of the tibial plateau fractures.更多还原