摘要
目的观察后内、前外侧联合入路,双/三接骨板内固定治疗累及后内髁的SchatzkerⅤ/Ⅵ型胫骨平台骨折的临床疗效。方法2005年4月-2008年4月,收治18例累及后内髁的SchatzkerⅤ/Ⅵ型胫骨平台骨折患者。男14例,女4例;年龄18～62岁,平均38.5岁;根据Schatzker分型:Ⅴ型12例,Ⅵ型6例;单纯累及后内髁13例,累及双后髁5例。患者均先作后内侧入路复位后内髁骨折块及内髁骨折,再作前外侧联合入路复位外髁骨折,同时处理半月板及前、后交叉韧带损伤。10例三接骨板(外、内、后)内固定,8例双接骨板(外、后内)内固定。结果术后切口均Ⅰ期愈合,无伤口感染、皮瓣坏死、骨筋膜室综合征、慢性骨髓炎、骨不连等并发症发生。18例患者均获随访,随访时间12～48个月,平均24.4个月。术后1年膝关节屈曲100～130°,平均118.4°。根据Iowa膝关节功能评分标准评定:优12例,良4例,可2例,优良率88.9%。结论采用后内、前外侧联合入路,双/三接骨板内固定是治疗累及后内髁SchatzkerⅤ/Ⅵ型胫骨平台骨折的有效方法,后内髁骨折解剖复位、坚强内固定是手术成功的关键。
Objective To observe the clinical results of treatment of Schatzker Ⅴ/Ⅵ tibial plateau fracture involved posteromedial condyle through combined posteromedial and anterolateral approach and fixed with two or three plates. Methods From April 2005 to April 2008, 18 cases of tibial plateau fracture involved posteromedial condyle were treated, including 14 males and 4 females with an average age of 38.5 years old （range, 18-62 years old）. According to Schatzker classification, there were 12 cases of type Ⅴ and 6 cases of typeⅥ. The posteromedial condyle were involved in 13 cases and bilateral posterior condyle in 5 cases. All patients were given posteromedial fragment and medial condyle fracture reduction through posteromedial approach firstly, and then lateral condyle fracture reduction through anterolateral approach, and injury of meniscuses and cruciate ligaments were treated at the same time. Three plates （lateral, medial, posterior） were used in 10 cases and two plates （lateral, posteromedial） in 8 cases. Results All wounds achieved healing by first intention without complications such as infection, flap necrosis, osteofascial compartment syndrome, chronic osteomyelitis, nonunion. All patients were followed up for 12 to 48 months with an average of 24.4 months. The mean flexion of the knee was 118.4~ （range, 100-130~） 1 year after operation. According to Iowa evaluation system, 12 patients got excellent results, 4 good, and 2 fair; the excellent and good rate was 88.9%. Conclusion Combined posteromedial and anterolateral approach and fixed with two or three plates is effective in treatment of the Schatzker Ⅴ/Ⅵ tibial plateau fracture involved posteromedial condyle. Anatomical reduction and rigid internal fixation of the posteromedial fragment are critical to successful operation.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2009年第11期1319-1322,共4页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
胫骨平台骨折
内固定
联合入路
Tibial plateau fracture Internal fixation Combined approach
