摘要
目的探讨改良外侧胫骨平台骨折塌陷关节面复位方法的疗效。方法 2008年1月-2010年12月,收治48例(48膝)有关节面塌陷的外侧胫骨平台骨折患者。男32例,女16例;年龄16～79岁,平均45.8岁。致伤原因:交通事故伤27例,高处坠落伤5例,重物压伤8例,摔伤8例;均为新鲜闭合骨折。骨折根据Schatzker分型标准:Ⅱ型29例,Ⅲ型19例。术中通过凿开外侧骨皮质,完全显露塌陷关节面,将其下方松质骨向上夯实,同时复位关节面,采用自体髂骨植骨、锁定钢板内固定。结果术后患者切口均Ⅰ期愈合,无手术相关并发症发生。患者均获随访,随访时间1～3年,平均1.7年。末次随访时患者膝关节主动活动度为伸膝(—0.5±0.3)°,屈曲(136.9±8.8)°。X线片示术后1年随访时患者骨折均达骨性愈合,随访期间无内固定物断裂。末次随访时,根据Rasmussen临床评分标准,获优35例,良10例,中3例。根据Rasmussen放射评分标准,获优41例,良7例;其中关节面复位达优41例,良7例;冠状位对位、矢状位对位及髁间宽度均恢复满意。患者术前关节面塌陷(12.2±8.0)mm,术后即刻为(1.0±0.7)mm,末次随访时为(1.2±0.7)mm,术后即刻与末次随访时关节面塌陷程度与术前比较,差异均有统计学意义(P<0.05);术后即刻与末次随访时比较,差异无统计学意义(t=—1.42,P=0.20)。结论对于外侧胫骨平台骨折塌陷关节面采取凿开外侧骨皮质,直视下复位,有利于关节面良好复位,且可防止复位再丢失,其近期疗效良好,远期效果需进一步随访。
Objective To investigate the improved reduction technique for depression fractures of the lateral tibial plateau and its effectiveness. Methods Between January 2008 and December 2010, 48 patients （48 knees） with depression fractures of the lateral tibial plateau （Schatzker II or III fractures） were treated. There were 32 males and 16 females with an average age of 45.8 years （range, 16-79 years）. All fractures were fresh closed fractures, which were caused by traffic accident in 27 cases, by falling from height in 5 cases, by crushing in 8 cases, and by sustained falls in 8 cases. According to Schatzker classification, 29 cases were classified as type II and 19 cases as type III. The lateral cortex was cut off to expose the depression and compacted cancellous bone was elevated to reset the articular surface. After reduction, autologous iliac bone graft and locking plate internal fixation were used. Results Healing of incision by first intention was achieved in all patients, and no complication occurred. All patients were followed up 1.7 years on average （range, 1-3 years）. At last follow-up, the knee extension was （ — 0.5 ± 0.3）°, and the knee flexion was （136.9 ± 8.8）°. X-ray films showed that the fracture healing time was 52 weeks and no breakage of internal fixation occurred. According to Rasmussen clinical score, the results were excellent in 35 cases, good in 10 cases, and fair in 3 cases. According to Rasmussen radiographical score, the results were excellent in 41 cases, good in 7 cases; there were 41 excellent scores and 7 good scores of articular reduction; all gained good recovery of coronal and sagittal alignment and condylar width. The articular surface collapse was （1.0 ± 0.7） mm at immediate postoperatively and （1.2 ± 0.7） mm at last follow-up, showing no significant difference （t= — 1.42, P=0.20）, but significant differences were found when compared with that at preoperation [（12.2 ± 8.0） mm, P 〈 0.05]. Conclusion This improved technique can provide a satisfactory effectiveness of fracture reduction and can avoid loss of reduction. The short-term effectiveness is good, but futher follow-up is necessary to determine the long-term results.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2013年第1期12-16,共5页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
胫骨平台骨折
关节面蹋陷
关节面复位
内固定
Tibial plateau fracture Articular surface collapse Articular surface reduction Internal fixation
