摘要
[目的]探讨胫骨平台骨折术后行内固定翻修的指征、策略和临床效果。[方法]回顾2006年10月～2009年9月收治的胫骨平台骨折术后患者23例,均为首次术后4～12周症状改善不佳或出现内固定失败后来本院就诊。术前Schatzker分型Ⅳ型6例,Ⅴ型7例,Ⅵ型10例。入院后评估首次手术的不足并制定个体化的翻修手术方案。术中对骨折行重新复位,调整关节面和膝关节力线,并选择恰当的锁定或非锁定接骨板对内侧、外侧及后侧骨块进行充分固定。术后视膝关节稳定程度尽早开始功能锻炼。[结果]术后未发生感染、深静脉血栓等早期并发症。随访骨折均愈合良好,平均愈合时间为12.7周,未发现复位丢失和内固定失败。术后12个月膝关节功能评分(HSS)达77.9,较术前明显改善(P=0.000)。[结论]笔者认为胫骨平台骨折术后翻修的指征包括严重的关节面塌陷(>5mm)、膝关节力线不良(胫骨平台内翻角≥95°或≤80°)以及固定不充分。针对性的翻修手术辅以术后早期功能锻炼可获得良好的治疗效果。
[Objective] To analyze the indication,strategy and clinical outcome of the revision surgery for failed reduction and internal fixation of tibial plateau fractures.[Method]Totally 23 cases were reviewed between Oct 2006 to Sep 2009.All the patients（6 cases of Schatzker type IV,7 cases of type V,and 10 cases of type VI） were admitted after a failed primary surgery 4 to 12 weeks ago.Personalized revision surgeries were planned according to the potential reasons of failure.Specifically,the joint surface was reduced and the mechanical axis of knee was rebuilt.Proper internal fixation composed of locking and/or non-locking plates was selected to stabilize the medial,lateral,and posterior fracture fragments.Early rehabilitation was encouraged postoperatively.[Result]No early complication（infection or deep vein thrombosis et al.） was observed.All the fractures healed without loss-of-reduction or implant failure during follow-up.The average time of healing was 12.7 weeks.At 12 months postoperatively,the knee function recovered satisfactorily with an average HSS of 77.9.[Conclusion]The indication of revision surgery include significant articular depression（5mm）,malalignment（tibial plateau angle ≥95°or ≤80°）,and/or unsatisfactory stabilization.Provided well-planned revision surgery and early rehabilitation,good functional results have been achieved in most of the patients.
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2011年第20期1682-1685,共4页
Orthopedic Journal of China
基金
国家自然科学基金(编号:30901570)
南京市青年科技人才启动项目(编号:QYK10147)
关键词
胫骨平台骨折
并发症
翻修手术
内固定
tibial plateau fracture
complication
revision surgery
internal fixation
