Moore T M, Patzakis M J, Harvey J P
Department of Clinical Orthopedics, University of Southern California, Los Angeles.
J Orthop Trauma. 1987;1(2):97-119.
Results of a decade of experience with 988 tibial plateau fractures are presented. Maximum plateau depression was measured on initial and follow-up x-ray studies, and knee instability was clinically evaluated to identify minor and major fractures as a guide to management. Demographic, treatment, and complication data were gathered prospectively in 753 fractures. Four hundred thirty-seven "major" tibial plateau fractures (44% of cases) were treated operatively; the remainder were treated by traction. Three hundred twenty patients who sustained only a plateau fracture were followed from 1 to 10 years, with an average of 3.7 years. Nonsurgical treatment included Buck's traction (89% of closed treatment cases) or a "knee exerciser" device utilizing skeletal traction in a Hodgson-Pearson apparatus. Early intermittent passive and active knee motion was encouraged. The complication rate of traction was 8%. The complication rate in operated patients was 19%, much of which was due to infection. Methods for objective and subjective scoring of both traction and operative results were developed and utilized. Results show that anatomic reduction of plateau fractures, in addition to early motion, is a major factor contributing to successful management of this potentially disabling injury.
本文介绍了对988例胫骨平台骨折长达十年的治疗经验结果。通过初次及随访时的X线检查测量平台最大凹陷程度，并对膝关节稳定性进行临床评估，以区分轻度和重度骨折，为治疗提供指导。前瞻性收集了753例骨折患者的人口统计学、治疗及并发症数据。437例“重度”胫骨平台骨折（占病例的44%）接受了手术治疗；其余患者采用牵引治疗。320例仅发生平台骨折的患者接受了1至10年的随访，平均随访时间为3.7年。非手术治疗包括布氏牵引（占闭合性治疗病例的89%）或在霍奇森 - 皮尔逊装置中使用骨牵引的“膝关节锻炼器”。鼓励早期进行间歇性被动和主动膝关节活动。牵引治疗的并发症发生率为8%。手术患者的并发症发生率为19%，其中大部分是由感染引起的。我们制定并采用了牵引和手术结果的客观及主观评分方法。结果表明，除早期活动外，平台骨折的解剖复位是成功治疗这种可能导致残疾的损伤的主要因素。
