摘要
目的探讨腓骨头上入路外侧胫骨平台截骨联合外侧锁定钢板治疗单纯胫骨平台后外侧骨折的临床疗效。方法回顾性分析2014年1月至2017年2月中国人民解放军中部战区总医院骨科收治的11例单纯胫骨平台后外侧骨折患者资料。男8例,女3例;年龄21~55岁,平均41.8岁。所有患者均采用腓骨头上入路,术中根据后外侧主要骨折块的大小、方位行外侧胫骨平台截骨,直视下复位后外侧骨块并充分植骨,胫骨平台外侧锁定钢板于腓骨头上方尽量偏后放置固定后外侧骨块,术后6周内指导患者膝关节90°内功能锻炼。末次随访时根据Rasmussen膝关节功能评分评定疗效。结果手术时间55~90min,平均74min;术中出血40~120mL,平均70mL。随访时间12~35个月,平均17.5个月。无血管、神经损伤及切口感染等并发症发生。骨折均获骨性愈合,愈合时间10~15周,平均12.5周。随访期间,无内固定松动、断裂,无膝关节内、外翻畸形和骨折再移位,无膝关节不稳。末次随访时根据Ras-mussen膝关节功能评定疗效:优10例,良1例。结论腓骨头上入路外侧平台截骨联合胫骨平台外侧锁定钢板治疗单纯胫骨平台后外侧骨折是一种可供优先选择的方法。
Objective To explore the clinical efficacy of lateral osteotomy via the supra-fibular-head approach combined with lateral locking plating for simple posterolateral tibial plateau fractures. Methods From January 2014 to February 2017,11 patients with simple posterolateral tibial plateau fracture were treated at Department of Orthopaedics,General Hospital of Middle Military Command of PLA.They were 8 males and 3 females,aged from 21 to 55 years (average 41.8 years).In all of them the supra-fibular-head approach was used for lateral osteotomy according to the size and orientation of the fracture block.After the fracture was reset,a full bone graft was implanted under direct visualization,followed by fixation of the posterolateral bone mass with a lateral locking plate which was placed as far as possible above the fibular head.The patients were encouraged 6 weeks after surgery to do knee functional exercise within 90°.The therapeutic efficacy was evaluated at the final follow-up according to the Rasmussen’s criteria for knee functions. Results The average operative time was 74 minutes (from 55 to 90 minutes);the average intraoperative blood loss was 70 mL (from 40 to 120 mL).All the patients were followed up for 12 to 35 months (average,17.5 months).No neurovascular injury or incision infection was observed.Bony union was achieved in all patients after 10 to 15 weeks (average,12.5 weeks).Follow-ups found no implant loosening/breakage,genu valgum,genu varum,fracture redisplacement,or knee instability.According to the Rasmussen’s function evaluation of the knee joint,10 cases were rated as excellent and one as good. Conclusion Lateral osteotomy via the supra-fibular-head approach combined with lateral locking plating is a preferred treatment for simple posterolateral tibial plateau fractures.
作者
宋虎
左照光
孙再杰
汪国栋
蔡贤华
刘曦明
Song Hu;Zuo Zhaoguang;Sun Zaijie;Wang Guodong;Cai Xianhua;Liu Ximing(Hubei University of Chinese Medicine,Wuhan 430065,China;Department of Orthopaedics,General Hospital of Middle Military Command of PLA,Hubei University of Traditional Chinese Medicine,Wuhan 421002,China)
出处
《中华创伤骨科杂志》
CAS
CSCD
北大核心
2019年第2期166-169,共4页
Chinese Journal of Orthopaedic Trauma
基金
湖北省技术创新重大项目(2017ACA099)
湖北省卫计委一般项目(WJ2018H0064).
关键词
膝关节
骨折固定术
内
截骨术
胫骨平台后外侧骨折
手术入路
Knee joint
Fracture fixation, internal
Osteotomy
Posterolateral tibial plateau fracture
Surgical approach
