胫骨平台骨折治疗方式的研究进展

Research Progress on Treatment Methods for Tibial Plateau Fractures

摘要: 胫骨平台骨折是累及膝关节的重要关节内骨折，其治疗目的是复位关节面、重建下肢力线及尽早开始康复训练。随着对手术生物力学认识加深以及微创技术进步，其治疗方法也由以往传统的切开复位内固定(ORIF)逐渐向多样化、个性化及minimally invasive方向发展。本篇文献综述主要总结了胫骨平台骨折的分类以及治疗原则，介绍了非手术治疗、ORIF、微创经皮钢板内固定(MIPPO)、外固定架固定以及关节镜辅助下手术等不同方法的应用指征、操作要点及相关报道结果，并对近年来出现的新技术如机器人导航辅助手术进行讨论。研究表明，治疗方法选择应该根据骨折类型、软组织情况以及患者全身状况，在保证牢固固定的条件下尽可能少分离软组织，有利于功能恢复并且减少并发症。

Abstract: Tibial plateau fractures are important intra-articular fractures involving the knee joint. The main goals of treatment are to restore articular surface congruity, re-establish lower limb alignment, and allow early functional rehabilitation. With advances in the understanding of fracture biomechanics and the development of minimally invasive techniques, treatment strategies for tibial plateau fractures have gradually evolved from traditional open reduction and internal fixation (ORIF) to more diverse, individualized, and minimally invasive approaches. This review summarizes the classification and treatment principles of tibial plateau fractures and discusses the indications, surgical techniques, and clinical outcomes of different treatment methods, including conservative treatment, ORIF, minimally invasive percutaneous plate osteosynthesis (MIPPO), external fixation, and arthroscopy-assisted surgery. In addition, recent progress in emerging techniques, such as robot-assisted surgical navigation, is also reviewed. Current evidence suggests that treatment strategies should be selected according to fracture type, soft tissue condition, and the patient’s general status. Under the premise of achieving stable fixation, soft tissue dissection should be minimized whenever possible to promote postoperative functional recovery and reduce complications.