摘要
目的探讨研磨复位法在张氏微创保膝术治疗胫骨平台骨折中的应用效果。方法回顾性分析2015年3月至2017年4月河北医科大学第三医院收治的SchatzkerⅡ型或Ⅲ型胫骨平台骨折患者11例,其中男性7例,女性4例,年龄21~53岁,平均(41±11)岁;左侧5例,右侧6例;均为新鲜闭合骨折,致伤原因:交通事故伤4例,摔伤7例。术前采用X线片和CT三维重建确诊为胫骨平台骨折。术中采用张氏微创保膝术进行复位,对出现骨折块顶高的过度复位者进行研磨复位,术中透视及术后拍摄膝关节正侧位X线片验证复位效果。结果本组患者通过股骨髁研磨复位法均实现了顶起过高骨块的闭合复位,术中透视研磨前过高骨折块最高点至关节面的垂直距离为(4.3±1.8)mm,研磨后垂直距离变为(1.4±1.0)mm,结果显示差异具有统计学意义(t=4.913,P<0.05)。近端完成所有螺钉固定后,再次透视时未发现复位丢失。术后X线片再次证实复位满意。所有患者采用闭合复位和微创植入接骨板技术,无切口感染、重要血管神经损伤和内固定位置不良等并发症发生。结论 (1)股骨内外髁能够研磨到的部位,通过研磨挤压胫骨平台均能达到解剖复位。(2)股骨内外髁通过过伸、过屈不能研磨到的部位如髁间嵴部位,突出的部位可自行吸收,不影响关节的伸屈及稳定性。
Objective To explore the effectiveness of grinding reduction in the treatment of tibial plateau fractures. Methods From March 2015 to April 2017, 11 patients suffered from closed tibial plateau fractures （Schatzker type II or III） were included into our study. There were 7 males and 4 females with average age of 41 ± 11 years （21- 53）. Left in 5 cases and right in 6 cases. Fractures were identified with preoperative X-ray and CT scans. Four cases caused by traffic accident, 7 cases followed by a fall injury. All patients were treated with Zhang’s minimally invasive methods. Additional grinding reduction was used when fragments were above the normal articular surface and intra- operative fluoroscopy was used for inspection during reduction process. The post- operative radiographs of knee joint were taken for further validation. Results In this case series, the over-tamped fragments were all successfully reduced with the help of grinding reduction by femoral condyle. The vertical distance from the highest point of the overtamped fragments to the articular surface was 4.3±1.8 mm. After grinding reduction, the distance was 1.4± 1.0 mm. The results showed that the difference was statistically significant （t=4.913, P〈0.05）. After proximal fixation, no reduction loss was identified through intraoperative fluoroscopy. All patients underwent closed reduction and minimally invasive plate fixation. No infection, vascular injury, reduction failure or other complications were oberseved. Conclusions （1）Grinding reduction can effectively reduce the tibial plateau fractures anatomically within the motion range of medial and lateral femoral condyle. （2）The over-tamped fragments in the out of scope area of hyperextension and hyperflexion of medial and lateral femoral condyle such as intercondylar eminence of tibia absorb itself spontaneously with time, without affecting the extension, flexion and stability of knee joint.
出处
《中华老年骨科与康复电子杂志》
2017年第3期157-161,共5页
Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition)
基金
河北省优秀人才项目
2016年政府资助省级临床医学优秀人才项目
关键词
胫骨骨折
微创外科手术
研磨复位
Tibial fractures
Minimally invasive surgical procedures
Grinding reduction
