摘要目的 评价胫骨平台骨折手术治疗的中远期疗效,探讨影响骨折预后的因素.方法 采用回顾性分析的方法 分析43例胫骨平台骨折患者的病例资料,所有患者均行Sehatzker分型分类.随访指标包括:患者自我评价根据Macnab标准;膝关节功能评估采用Lysholm评分;放射学采用Rasmussen评分和Resnick-Niwoyama评分对骨折复位情况和关节退变程度进行评价;膝关节活动度;关节间隙和关节面高度变化.所得数值采用SPSS 11.5进行统计学分析.结果 43例患者总体优良率达到60%,患侧膝关节平均活动范围是113°.Lysholm评分平均为83.1分(17～98分).多元逐步回归分析得出Lysholm评分同患侧关节面塌陷高度、患侧关节间隙呈负相关.单髁平台骨折评分高于双髁平台骨折.影像学评分,Rasmussen评分平均14,0分(10～18分);患侧关节有81,4%(35/43例)出现骨关节炎表现,健侧仅有23.3%(10/43例);Rasmussen评分最差(11.5分)和最满意(16分)两组患者的骨关节炎发生率均为100%.结论 胫骨平台骨折术后膝关节功能同患侧关节面下陷高度、关节间隙变化以及年龄相关,单髁平台骨折较双髁平台骨折预后好.

abstractsObjective To analyze the mid- and long-term surgical effect of tibial plateau fractures, and to explore the factor that affected the curative effect. Methods The clinical data of 43 patients with tibial plateau fractures (from May 1995 to November 2004) was retrospectively reviewed. All fractures were classified according to the Schatzker classification. There were 25 men and 18 women, with the mean age of 47.8 years (26 to 73 years). Thirty six patients had isolated fractures and seven had multiple fractures. After 57.4 months follow-up was done in all 43 patients. Functional Results of these patients were graded with self-evaluation of the Macnab scores and the Lysholm scores. Radiologic Results were graded with the Rasmussen score and Resnick-Niwoyama score to evaluate the reduction of fracture and the degradation of the knee. The joint space, and depressed height of articular surface were measured. Statistical analysis was performed by means of the sofeware SPSS11.5. Results According to the MacNab score, the patients with tibial plateau fractures average degree of satisfaction was 60%, and along with a mean knee ROM from 0° to 113°. Func-tional Results showed a mean Lysholm score of 83.1 points (range, 17-98 points). According to the stepwise multiple regression analysis, in the monoeondylar fractures of the tibial plateau, the Lyshoha scores was connection with the joint space and depressed height of articular surface, and the relationship was negative correlation. The Lyshoha score was negative correlation with depressed height of articular surface and articu-lar gaps. Monoeondylar fractures showed statistically significant better functional Results compared to bi-condylar fractures. In Radiologic result of mean Rasmussen score was 14 points (10-18 points). In 81.4% (35/43 cases)of the patients" injuried knees arise secondary osteoarthritis, and 23.3%(10/43 cases) uninjured side happened osteoarithritis. Conclusion Mid and long-term Results after open reduction and internal fixa-tion for tibial plateau fractures are effeeted by depressed height, articular gaps and age. At the same time monocondylar fractures will get better recovery than bicondylar fractures.