CAJ | 학술논문

目的探讨分期治疗复杂性胫骨平台骨折的可行性及疗效. 方法 2007年12月至2011年12月采用分期治疗8例复杂性胫骨平台骨折患者,男6例,女2例;年龄30～65岁,平均49.3岁;骨折按Schatzker分型:Ⅳ型2例,Ⅴ型4例,Ⅵ型2例.Ⅰ期处理:8例患者均急诊手术,给予跨膝关节外固定支架固定+骨筋膜间室切开减压,其中3例腘动脉损伤患者行大隐静脉移植修复.Ⅱ期处理:7例患者将外固定转换为内固定,行切开复位胫骨近端解剖锁定板固定;另1例患者因局部软组织条件差,行克氏针有限内固定联合外固定支架固定. 结果所有患者的手术切口均一期愈合,无切口感染、皮缘坏死、内固定物外露等并发症发生.术后平均随访14个月(10～24个月),骨折均获骨性愈合,X线愈合时间平均为5个月(4 ～8个月).本组7例患者膝关节活动度均超过90°,平均伸膝2.6°,平均屈膝104.5°;另1例患者出现一定程度的膝关节僵硬,活动度为5°～55°.按美国特种外科医院评分系统评定疗效:优6例,良1例,可1例. 结论分期治疗复杂性胫骨平台骨折是一种有效的处理方式,有利于降低其术后软组织并发症发生率和改善其疗效.
목적 탐토분기치료복잡성경골평태골절적가행성급료효. 방법 2007년12월지2011년12월채용분기치료8례복잡성경골평태골절환자,남6례,녀2례;년령30～65세,평균49.3세;골절안Schatzker분형:Ⅳ형2례,Ⅴ형4례,Ⅵ형2례.Ⅰ기처리:8례환자균급진수술,급여과슬관절외고정지가고정+골근막간실절개감압,기중3례객동맥손상환자행대은정맥이식수복.Ⅱ기처리:7례환자장외고정전환위내고정,행절개복위경골근단해부쇄정판고정;령1례환자인국부연조직조건차,행극씨침유한내고정연합외고정지가고정. 결과 소유환자적수술절구균일기유합,무절구감염、피연배사、내고정물외로등병발증발생.술후평균수방14개월(10～24개월),골절균획골성유합,X선유합시간평균위5개월(4 ～8개월).본조7례환자슬관절활동도균초과90°,평균신슬2.6°,평균굴슬104.5°;령1례환자출현일정정도적슬관절강경,활동도위5°～55°.안미국특충외과의원평분계통평정료효:우6례,량1례,가1례. 결론 분기치료복잡성경골평태골절시일충유효적처리방식,유리우강저기술후연조직병발증발생솔화개선기료효.
Objective To assess the feasibility of staged management of complex fractures of tibial plateau.Methods Between December 2007 and December 2011,8 cases of complex fractures of tibial plateau were treated by staged management.Their mean age was 49.3 (range,30 to 65) years.Fractures were classified according the Schatzker classification of tibial plateau fractures.There were 2 cases of Schatzker Ⅳ,4 Schatzker Ⅴ and 2 Schatzker Ⅵ.At the first stage,they were treated with bridging external fixation plus open decompression of the osteofascial compartment,and 3 cases of them with reconstruction of the popliteal artery by great saphenous vein graft.At the second stage,7 cases underwent open reduction and definitive stabilization with an anatomic locking plate,and the other one was treated with K-wire fixation and external fixator.Results All operative incisions healed well without any complications like wound infection,skin necrosis or exposure of implants.A mean follow-up of 14 (range,10 to 24) months revealed bony union of all fractures.The mean time for X-ray union was 5 (range,4 to 8) months.Range of knee motion was from 2.6° to 104.5° in 7 cases,with a mean of over 90°,but from 5° to 55° in one patient with knee stiffness.According to the HSS (The Hospital for Special Surgery Score) system,6 cases were excellent,one fine and one fair,giving a fine.Conclusion Staged management of complex fractures of tibial plateau is effective,because it can decrease soft tissue complications and improve the outcomes of treatment.