摘要
目的：探讨应用CT三维重建和关节镜监视下治疗胫骨平台骨折中的价值。方法：收集22例胫骨平台骨折病例，术前常规进行X线摄片，按Schatzker分类：Ⅰ型4例，Ⅱ型5例，Ⅲ型2例，Ⅳ型6例，Ⅴ型3例，Ⅵ型2例。然后对骨折在3D重建图像后再分型：前外象限4例，后外象限8例，前内象限4例，后内象限2例，涉及内和外象限4例。在关节镜监视下结合3D重建对骨折进行复位和内固定。结果-22例胫骨平台骨折3D重建图像分型与关节镜术中的诊断一致。平台骨折需要植骨15例。松质骨螺钉固定4例，单侧支撑钢板内固定8例，双侧支撑钢板内固定4例，单侧支撑钢板加松质骨螺钉固定6例。随访3个月～2年，根据HSS膝关节评分标准：优18例，良2例，可2例。结论：螺旋CT及3D重建补充了在胫骨平台三维空间上新的骨折分型，对手术入路、复位和内固定有指导意义。关节镜监视下有助于骨折复位，对骨折块的血运干扰少，骨折愈合快。
Objective： To explore the value of three-dimensional （3D）reconstruction of spiral CT and arthroscopic technique in treating tibial plateau fractures. Methods： Twenty-two patients with tibial plateau fracture took radiographs. According to Schatzker classification, type Ⅰ in 4 cases, type Ⅱ in 5, type Ⅲ in 2, type Ⅳ in 6, type Ⅴ in 3, type Ⅵ in 2. Then the patients were re-classified after 3D reconstruction imaging with spiral CT, anterolateral quadrant in 4 cases, posterolateral quadrant in 8, anteromedial quadrant in 4, posteromedial quadrant in 2, medial and lateral quadrant in 4. All tibial plateau fractures were reduced and fixed under arthroscope and 3 D reconstruction. Results： The type of re-classified fractures according to spiral CT and 3D reconstruction images was coincidence with that of diagnosis during opereation. Fifteen cases needed bone graft. Fixation with cancellous bone screw, unilateral buttress plate, bilateral buttress plate, unilateral buttress plate and cancellous bone screw had 4,8,4,6 cases respectively. All the patients were followed up from 3 months to 2 years. According to HSS criterion, 18 cases obtained excellent result,2 good, 2 poor. Conclusion： Spiral CT and 3 D reconstruction imaging replenish a new threedimensional classification of tibial plateau fracture and provide better guidance for the approach of operation, reduction and fixation. Arthroscopic technique conduce reduction for fracture,it have less influence on blood circulation of bone molar, and can accelerate bone healing.
出处
《中国骨伤》
CAS
2007年第1期24-25,共2页
China Journal of Orthopaedics and Traumatology
关键词
胫骨平台骨折
关节镜
骨折固定术
内
Tibial plateau fracture
Arthroscopes
Fracture fixation, internal
