Hertel P
Abteilung Unfallchirurgle, Martin-Luther-Krankenhaus Berlin.
Unfallchirurg. 1997 Jul;100(7):508-23. doi: 10.1007/s001130050151.
The classification of tibial plateau fractures is based on morphological criteria according to AO/ASIF and Schatzker or on functional criteria according to Moore. A total of 81 acute tibial plateau fractures were operated on over a 6-year period. The patient data and the operative procedure are given (not including late results). Some 6% of ligamentous lesions were treated conservatively. Bicondylar osteosynthesis was performed in 11%, and 14% of the operations were minimally invasive procedures. In 61.7% the plateau was fixed by a buttress plate. Autologous cancellous bone from the iliac crest was implanted into the fracture, especially into depressed wedge fractures (Type AO/ASIF B3 or Moore Type IV). In 39.5% of the cases a corticocancellous wedge-shaped bone chip from the iliac crest was used. Complications were rare, and no infection was observed. Most important are the soft tissue balance, the timing of surgery, choice of longitudinal incisions directly above the lesion, and a stabilization procedure which maintains blood flow and coverage of the fracture. The operative procedures are described including tibial plateau fractures in children and the management of complications. In special situations a conservative treatment is still useful.
胫骨平台骨折的分类是基于AO/ASIF和Schatzker的形态学标准或Moore的功能标准。在6年的时间里，共对81例急性胫骨平台骨折进行了手术治疗。给出了患者数据和手术过程（不包括远期结果）。约6%的韧带损伤采用保守治疗。11%的病例采用双髁接骨术，14%的手术为微创手术。61.7%的病例中，使用支撑钢板固定平台。取自髂嵴的自体松质骨被植入骨折部位，尤其是凹陷楔形骨折（AO/ASIF B3型或Moore IV型）。39.5%的病例使用了取自髂嵴的皮质松质楔形骨块。并发症很少见，未观察到感染情况。最重要的是软组织平衡、手术时机、在损伤部位正上方选择纵向切口以及维持骨折部位血流和覆盖的稳定手术。文中描述了手术过程，包括儿童胫骨平台骨折及并发症的处理。在特殊情况下，保守治疗仍然有效。
