摘要
目的探讨后内侧联合前外侧入路复位固定治疗后外侧关节面塌陷的复杂胫骨平台骨折的疗效。方法回顾性分析2010年7月至2012年9月收治并成功随访的19例复杂胫骨平台骨折患者资料，男11例，女8例；平均年龄49．5岁（30～65岁）。骨折根据Schatzker分型：Ⅴ型14例，Ⅵ型5例。所有患者的后外侧胫骨平台关节面骨折块通过前外侧入路复位，后外侧移位的皮质骨经后内侧入路复位，并用1块塑形的重建钢板固定于胫骨近端的后外侧，钢板近端不放置螺钉。胫骨平台外侧解剖钢板固定后外和外侧胫骨平台的骨折前外侧放置。随访指标包括手术时间、骨折愈合时间、术后即刻和术后1年X线片所示胫骨平台内翻角和后倾角以及术后1年患者的膝关节活动度。末次随访时采用美国特种外科医院评分系统（HSS）评定膝关节功能。结果平均手术时间为164．7min（120—280min）。19例患者术后平均随访17．8个月（12～30个月）。所有患者的骨折均一期愈合，愈合时间平均为15．2周（12～18周）。术后即刻和术后1年的X线片示胫骨平台内翻角平均为87．2°±1．0°、87．1°±1.1°；后倾角平均为7．0°±1．1°、7．0°±1．0°，术后即刻与术后1年比较差异均无统计学意义（P〉0．05）。术后1年患者膝关节活动度平均为128．7°（0～135°）。其中2例患者出现后外侧关节面高度丢失（关节面塌线≥2mm）。末次随访时HSS评分平均为92．6分（88～97分）。结论复杂胫骨平台后外侧关节面骨折可通过后内侧联合前外侧入路复位，同时通过后内侧入路置入后外侧支撑钢板及前外侧钢板联合固定，手术效果安全、可靠。
Objective To explore the treatment of complex tibial fractures associated with collapse of posterolateral articular surface （Schatzker types VI and V ） using reduction via posteromedial and antero- lateral approaches. Methods From July 2010 to September 2012, 19 patients with complex tibial fracture were treated and followed up by our department. They were 11 males and 8 females, with an average age of 49.5 years （range, from 30 to 65 years） . Their fractures were classified as Schatzker type V in 14 cases and Schatzker type VI in 5. All fractures involved the posterolateral tibial plateau. They were all reduced via the posteromedial and anterolateral approaches. The posterolateral cortical fragments were pushed anteriorly and a curved reconstruction plate was used to maintain the reduction via the posteromedial approach. An anatomically designed plate was lastly placed on the anterolateral side of the proximal tibia to fix the lateral articular surface of the proximal tibia. The knee function was evaluated by The Hospital fou Special Surgery Score（HSS） at the last follow-ups. Results The mean operation time was 164. 7 min （range, from 120 to 280 rain） . All fractures united clinically and radiographically after an average time of 15.2 weeks （range, from 12 to 18 weeks）. No nonunion, injury to the common peroneal nerve, varus deformity, implant failure, or no deep wound infection occurred. At immediate postoperation and one year postoperation, the mean tibial plateau angle （TPA） was 87.2°±1.0° and 87. 1°± 1.1° , and the mean posterior slope angle （PSA） was 7.0°±1.1° and 7.0°± 1.0° , respectively, showing no significant difference between the 2 time points （ P 〉 0. 05） . At one year postoperation, the average motion of the affected knee was 128.7° （range, from 0 to 135°） . The posterolateral tibial articular malreduetion （≥2 mm step-off） was seen in 2 patients. The mean HSS score at the last follow-ups was 92. 6 （range, from 88 to 97）. Conclusions Posterolateral fragments in complex tibial plateau fractures can be reduced and fixed via the posteromedial and anterolateral ap- proaches, and can be fixed by a posterolateral buttress plate through the posteromedial approach and by an anterolateral locking plate. This is a safe and effective treatment for posterolateral tibial plateau fractures al- ternatively.
出处
《中华创伤骨科杂志》
CAS
CSCD
北大核心
2015年第7期559-564,共6页
Chinese Journal of Orthopaedic Trauma
关键词
膝关节
骨折
骨折固定术
内
骨板
Knee joint
Froctures, bone
Fracture fixation, internal
Bone plates
