复杂胫骨平台骨折术后疗效不佳原因分析.doc

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1、复杂胫骨平台骨折术后疗效不佳原因分析【摘要】　　［目的］回顾分析复杂胫骨平台骨折术后疗效不佳的原因，提出相应的避免方法。［方法］1999年8月—2005年9月治疗的62例SchatzkerⅣ—Ⅵ型骨折中，根据Rasmussen膝关节功能评分标准，对评判术后疗效为可和差的21例进行综合分析。21例均采用手术治疗，伤后到手术的平均时间为48d（1~12d），18例采用切开复位钢板内固定，其中5例运用自体髂骨移植；3例采用闭合撬拨中空螺钉固定。［结果］评为可的18例中，SchatzkerⅣ11例，Ⅴ4例，Ⅵ3

2、例；差的3例中Ⅳ—Ⅵ型各占1例，术后伴有切口裂开、感染或切口皮肤坏死。随访时间平均338个月（6~72个月），主要出现膝关节疼痛，内外翻，膝关节伸屈活动受限等。［结论］影响复杂胫骨平台骨折术后疗效的因素有骨折分型与治疗方案不一致、关节功能锻炼不及时、手术时机不当、关节面复位的质量与术者的心理因素等。【关键词】胫骨平台骨折内固定器疗效原因分析　　Abstract:［Objective］Toanalyzeprognosticrelativefactorsintreatmentbyevaluatingthes

3、urgicalresultsofcomplextibialplateaufractureretrospectivelyandprovidecorrespondingsuggestions.［Methods］62caseswithcomplextibialplateaufractureweretreatedoperativelybetweenAug.1999andSep.2005.Amongthem,21caseswerefoundwithunsatisfiedresultsduetopain,deform

4、ityandlimitationofflexion-extensionfunction.AccordingtotheSchatzkerclassification,thereweretypeⅣfracturein12cases,typeⅤfracturein5casesandtypeⅥfracturein4cases.Of21cases,therewere13malesand8females,theaverageagewas382years(range,21to63years).Themechanism

5、sofinjuryweretrafficaccidentin14cases,tumblein6casesandfallin1case.21caseswhichwereallclosefracturewereoperatedwithanaverageintervalof48daysfrominjurytosurgery(range,1to12days).Duringoperation,18casesweretreatedwithopenreductionandinternalfixationwithpla

6、tes,of5casesweretreatedwithgraftingautologousiliacbone;and3casesweretreatedwithpryingreductionandinternalfixationwithscrews.［Results］Theaverageperiodoffollow-upwas338months(range,6to72months).AccordingtoRasmussen’scriterion,theresultofthetreatmentwaseval

7、uatedasfairin18cases,11casesofwhichweretypeⅣfracture,4casestypeⅤfractureand3casestypeⅥfracture;poorin3cases,1caseofwhichwastypeⅣfracture,1casetypeⅤfractureand1casetypeⅥfracture.Complicationsincludedwounddehiscencein4cases,2ofwhichwereskinnecrosisofincisio

8、n;infectionin2cases.The21casesweresufferedfromposttraumaticarthritisofthe4kneejoint,12ofwhichwerelimitationofflexion-extensionfunction.［Conclusion］Discouragedresultsofcomplextibialplateaufracturearesignificantlyrela