目的 分析累及后柱的SchatzkerⅡ型胫骨平台骨折手术治疗失败的原因,并根据平台后外侧柱骨折形态学提出相应治疗方案. 方法 对26例手术治疗失败的累及后柱的SchatzkerⅡ型胫骨平台骨折患者资料进行回顾性分析,对骨折类型、固定方法、骨折形态学特征等因素进行综合评估,分析造成手术失败的可能原因;同时根据影像学资料及形态学特点制定具体手术计划. 结果 26 例失败患者均伴有严重的膝关节功能障碍,翻修前Rasmussen评分8~17分,HSS膝关节功能评分36~68分. 其中手术方法不当8例,内固定方法选择不当18例. 翻修术后Rasmussen 评分25~28分、HSS评分80~93分,较术前均明显改善( P<0. 05 ). 结论 骨折复位不良、固定方法选择不当是累及后柱的SchatzkerⅡ型胫骨平台骨折手术失败的主要原因,根据骨折类型及形态学特征制订适当的治疗计划是手术成功的关键.%Objective To analyze causes for failed surgical treatments of Schatzker type Ⅱ tibial plateau fractures in-volving the posterior column and to make preoperative plan for morphological. Methods 26 cases underwent failed surgical treatments for Schatzker type Ⅱ tibial plateau fractures involving the posterior column. They were retrospec-tively analyzed. Factors including fracture pattern, fixation method, quality of reduction and postoperative rehabilita-tion,were evaluated to find the possible causes. Moreover, preoperative plan were made based on the imaging data and morphological. Results All the 26 cases presented severe functional impairment with the Rasmussen sore ranged 8 to 17 points;HSS score ranged 36 to 68 points before revision surgery. Improper treatment strategy was found to be re-sponsible for failure in 8 cases and improper fixation method in 18 cases. There were obviously improved in either Rasmussen score (25 to 28 points) or HSS score (80 to 93 points) comparing with the preoperation (P<0. 05). Conclusions Malreduction,improper fixation are major reason for failure of surgical treatment. The key to successful surgical treatment is a well-designed treatment scheme based on the specific fracture type and morphological charac-teristics.
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