胫骨平台骨折的治疗策略与进展

摘要

胫骨平台骨折是骨科常见的创伤之一,包括多种骨折类型,从简单型到复杂型,从单纯骨折到合并关节内骨折,围关节组织损伤等等.胫骨平台是人体重要的负重部位,胫骨平台骨折一旦处理不当,会导致疼痛、畸形等并发症发生,严重影响患者生活质量.随着近年来外科技术的发展,骨科医生可以选择多种技术手段处理胫骨平台骨折,但是如何正确的诊断与分型,如何选择合适的处理方案以及恰当的固定方式,对患者肢体功能的恢复至关重要.X线片是骨科最常用的影像学检查方法之一,也是诊断胫骨平台骨折的首选辅助方法,临床上大多数胫骨平台骨折患者均可通过X线片确诊以及进行准确的分型.由于分辨率高,CT扫描检查可以发现X线上很难发现的细微骨折,为临床诊断分型提供更详细的信息,弥补了单纯Schatzker分型的不足.而MRI在诊断韧带、半月板、关节软骨等围关节组织损伤中发挥着重要的作用.胫骨平台手术入路主要包括前外侧入路、内侧入路、后内侧入路、后侧入路、前正中入路等.针对不同类型的平台骨折需根据实际情况选择合适的入路.其中常用的入路为前外侧入路和后内侧入路,前外侧入路适合于大多数胫骨平台骨折(Schatzker Ⅰ、Ⅱ、Ⅲ型),当内侧平台骨折累及后侧平台,胫骨后侧干骺端骨折或者是需要对后侧骨皮质加固的骨折多宜采用后内侧入路.普通钢板、锁定钢板、双钢板法以及外固定支架是处理各型胫骨平台骨折的重要方式,其中双钢板法多用于复杂型胫骨平台骨折患者.本文对X线片、CT扫描、MRI在胫骨平台骨折中的应用进行分类综述、分析,对胫骨平台骨折的固定方式进行深入探讨,为临床医生提供诊断思路以及治疗策略.%Tibial plateau fracture,one of the most common fractures,includes simple and complicated fractures.Inappropriate treatment could result in pain and deformity,which has a bad effect on patient life.With the development of the surgical technique,a lot of methods could be selected when an orthopedist deals with these fractures.X-ray,one of the most common assistant examination,is the preferred method for tibial plateau fracture and could diagnose most of these fractures.Due to high resolution,CT scan could find these micro-fractures which X-ray cannot find and it could supplement the Schatzker type.MRI could find ligament,meniscus and arthrodial cartilage injury.Surgical approach includes anterolateral approach,medial approach,posteromedial approach,post approach,anterior approach.Anterolateral approach could be used for most of tibial plateau fractures.Posteromedial approach is used for medial plateau fracture involving post plateau fracture or post plateau fracture alone.Common plate,locking plate,dual plate and external fixation are commonly used fixation method.Dual plate is often used for complicated tibial plateau fracture.However,how to make accurate diagnosis and choose appropriate fixation is crucial for patients.We will summarize the application of X-ray,CT scan and MRI in diagnosis of tibial plateau fracture.Commonly used approaches to the proximal tibia,which together allow for the treatment of any proximal tibia fracture,will be described in this article.