胫骨平台骨折合并胫骨结节骨折的临床治疗

摘要

Objective To evaluate the treatment effect of tibial plateau fractures complicating by tibial tubercle fracture.Methods The treatment effect of 21 patients with tibial plateau fractures and tibial tubercle fractures admitted to our department from January 2009 to June 2013 was analyzed retrospectively,including 12 males and 9 females,aged from 21 to 65 years old,with the average age of 33.5 years old.21 patients underwent open reduction and internal fixation,in whom 6 patients (28.6％) underwent tibial plateau fixing rearward with full threaded cortical screw,15 patients (71.4％) underwent tibial plateau fixing with 1/3 tubular plate.Results All patients were followed up for 13-25 months,with the average of 15.6 months.One patient had suffered pain due to a prominent screw in the tibial tubercle,and the pain disappeared after removing the screw.The average HSS score of knee joint was 88.2 points (60-96 points) after one year.There were no cases of necrosis of skin,deep infection,loosening and breakage of internal fixation.Conclusion Tibial plateau fracture complicating by tibial tubercle fracture can be firmly fixed with 1/3 tubular plate or full threaded cortical screw,with early knee joint exercises,which has achieved good clinical results.%目的 探讨胫骨平台骨折合并胫骨结节骨折的临床治疗效果.方法 回顾性分析2009年1月至2013年6月间本科收治的21例胫骨平台骨折合并胫骨结节骨折患者的临床治疗效果,其中男12例,女9例.最大年龄为65岁,最小年龄为21岁,平均33.5岁.21例患者均行骨折切开复位内固定术,6例患者(28.6％)使用全螺纹皮质螺钉向后方固定胫骨结节,15例患者(71.4％)使用1/3管形钢板固定胫骨结节.结果 21例患者均获得随访,随访时间为13 ～ 25个月,平均为15.6个月.1例患者因胫骨结节突出的螺钉造成疼痛,术后4个月胫骨结节处骨折愈合予拆除螺钉,疼痛消失.术后1年患者的膝关节HSS评分平均为88.2分(60～96分),术后均无发生切口皮肢坏死、深部感染、内固定松动及断裂等并发症.结论 对胫骨平台骨折合并胫骨结节骨折采用1/3管形钢板单皮质螺钉固定或使用全螺纹皮质螺钉固定,胫骨结节固定牢固,膝关节能早期活动,取得了良好的临床效果.