Gür Bülent, Akman Senol, Aksoy Bülent, Tezer Mehmet, Oztürk Irfan, Kuzgun Unal
Sişli Etfal Eğitim ve Araştirma Hastanesi, Ortopedi ve Travmatoloji Kliniği, Istanbul.
Acta Orthop Traumatol Turc. 2003;37(2):113-9.
This study was designed to determine surgical indications in tibial plateau fractures and to evaluate the effect of surgical treatment on the outcome.
Forty patients (12 women, 28 men; mean age 39 years; range 18 to 75 years) underwent surgical treatment for 41 tibial plateau fractures. Final evaluations included 37 patients (38 knees). Fractures were classified according to the Schatzker's system, being type 1 (11 fractures), type 2 (11), type 3 (1), type 4 (6), type 5 (5), and type 6 (7). The indications for surgery were defined as the presence of depression, displacement, and instability being greater than 4 mm, 10 mm, and 10 degrees, respectively. The mean follow-up was 35.8 months (range 6 to 107 months).
Clinical results were assessed using the Rasmussen criteria. Successful results accounted for 86.8%. The results were excellent, good, moderate, and poor in 14 knees (36.8%), 19 knees (50%), three knees (7.9%), and 2 knees (5.3%), respectively. Postoperative complications included deep (2 patients) and superficial (2 patients) infections, malunion in two patients, arthrofibrosis in three patients, and myositis ossificans in one patient. Radiologic evaluations were based on the Resnic and Niwayama's system, which showed successful outcome in 73.6%. The results were excellent in 11 knees (28.9%), good in 17 knees (44.7%), moderate in six knees (15.8%), and fair in four knees (10.6%).
In order to achieve satisfactory results in tibial plateau fractures that meet surgical indications including depression (>4 mm), displacement (>10 mm), and instability (>10 degrees), special attention should be given to obtain a rigid osteosynthesis with early mobilization and to avoid weight-bearing until bone healing is completed.
本研究旨在确定胫骨平台骨折的手术指征，并评估手术治疗对预后的影响。
40例患者（12例女性，28例男性；平均年龄39岁；年龄范围18至75岁）因41例胫骨平台骨折接受手术治疗。最终评估纳入37例患者（38个膝关节）。骨折根据Schatzker分型系统进行分类，其中1型（11例骨折）、2型（11例）、3型（1例）、4型（6例）、5型（5例）和6型（7例）。手术指征定义为分别存在大于4mm的凹陷、大于10mm的移位以及大于10°的不稳定。平均随访时间为35.8个月（范围6至107个月）。
采用Rasmussen标准评估临床结果。成功结果占86.8%。结果分别为优、良、中、差的膝关节有14个（36.8%）、19个（50%）、3个（7.9%）和2个（5.3%）。术后并发症包括深部感染（2例患者）和浅表感染（2例患者）、2例患者骨不连、3例患者关节纤维性变以及1例患者骨化性肌炎。放射学评估基于Resnic和Niwayama系统，显示成功结果占73.6%。结果为优的膝关节有11个（28.9%）、良的有17个（44.7%）、中的有6个（15.8%）、差的有4个（10.6%）。
为了在符合包括凹陷（>4mm）、移位（>10mm）和不稳定（>10°）等手术指征的胫骨平台骨折中取得满意结果，应特别注意获得牢固的骨固定并早期活动，且在骨愈合完成前避免负重。
