Tscherne H, Lobenhoffer P
Trauma Department, Medizinishce Hochschule Hannover, Federal Republic of Germany.
Clin Orthop Relat Res. 1993 Jul(292):87-100.
The objective of treatment of tibial plateau fractures is precise reconstruction of the articular surfaces, stable fragment fixation allowing early motion, and repair of all concomitant lesions. A classification scheme is employed to include the high incidence of concomitant lesions in specific fracture types. The term "complex trauma" is used for extensive injuries involving multiple structural elements of the knee joint. Exact grading of the soft-tissue injury is crucial for the treatment plan. The authors suggest a four-grade classification system of closed and open soft-tissue injury. Preferred treatment is open reduction and internal fixation (ORIF) in all displaced and unstable tibial plateau fractures. A stepwise approach is used in complex knee trauma. Primary treatment includes closed reduction, wound debridement, if necessary, and external fixation of the femur and lower leg ("transfixation"). Open reduction and internal fixation and complex bone and soft-tissue reconstructions are performed in a second operation after recovery of the soft tissues. A follow-up study of 190 of 244 cases of tibial plateau fractures treated in the authors' institution from 1981 to 1987 showed good results after operative treatment, even in extensive fractures, with a tolerable complication rate. The functional recovery was relatively impaired in multiple injured patients and in complex knee trauma.
胫骨平台骨折的治疗目标是精确重建关节面、实现稳定的骨折块固定以允许早期活动，并修复所有并发损伤。采用一种分类方案以纳入特定骨折类型中并发损伤的高发生率。“复杂创伤”一词用于涉及膝关节多个结构要素的广泛损伤。准确分级软组织损伤对于治疗方案至关重要。作者提出了一种闭合性和开放性软组织损伤的四级分类系统。对于所有移位和不稳定的胫骨平台骨折，首选治疗方法是切开复位内固定（ORIF）。在复杂膝关节创伤中采用分步方法。初始治疗包括闭合复位、必要时的伤口清创以及股骨和小腿的外固定（“贯穿固定”）。在软组织恢复后，二期手术进行切开复位内固定以及复杂的骨和软组织重建。对作者所在机构1981年至1987年治疗的244例胫骨平台骨折中的190例进行的随访研究表明，即使是广泛骨折，手术治疗后效果良好，并发症发生率可接受。在多发伤患者和复杂膝关节创伤中，功能恢复相对受损。
