胫骨平台骨折术中下肢力线的恢复与疗效分析  

Restoration of the axial alignment of the lower extremity during operation of fracture of tibial plateau and curative effect analysis

作　　者：陆晴友[1] 彭庄[1] 席秉勇[1] 

机构地区：[1]同济大学附属东方医院骨科,上海市即墨路150号200120

出　　处：《中国矫形外科杂志》2008年第4期256-259,共4页Orthopedic Journal of China

摘　　要：[目的]探讨胫骨平台骨折术中下肢力线的恢复与疗效。[方法]自2000年5月～2005年6月,45例胫骨平台骨折病人,其中男25例,女20例,平均45.3岁。骨折分型:SchatzkerⅠ型3例,Ⅱ型10例,Ⅲ型19例,Ⅳ型6例,Ⅴ型5例,Ⅵ型2例,均行关节镜辅助下切开复位植骨钢板螺钉内固定,同时注意恢复正常的下肢力线。下肢力线的恢复以健侧为参照标准。测量方法:自髂前上棘至第1、2趾间拉一直线,计算髌骨中心至该直线的垂直距离,并与健侧比较。[结果]45例患者40例获得随访,随访时间6～24个月,平均15个月,按Rasmussen膝关节评分标准,结果:优24例,良11例,可3例,差2例,优良率达87.5%,膝关节功能与下肢力线正常与否密切相关。部分病例术后发生下肢力线的异常,其主要原因为:(1)半月板切除过多导致膝关节内载荷的重新分布;(2)患肢负重过早,使已复位的关节面再次塌陷;(3)骨折类型复杂,普通支持钢板难以达到骨折块之间的加压固定而造成骨折移位。[结论]术中下肢力线的纠正是膝关节功能恢复的重要保证,同时,要充分考虑导致术后下肢力线异常的主要因素并给予相应处理。[ Objective] To investigate the restoration of the axial alignment of the lower extremity during operation for fracture of tibia plateau and to assess the curative effect. [Method] A retrospective analysis of 45 cases of fracture of tibial plateau were conducted from May 2000 to June 2005, 25 male cases and 20 female, mean age were 45.3. The type of fracture.3 cases were Schatzker Ⅰ ,10 were type Ⅰ ,19 were type Ⅲ ,6 were type Ⅳ, 5 were type Ⅴ ,2 were type Ⅵ. All cases were treated with open reduction, bone graft and internal-fixation with plate and screw under arthroscopy-assisted, and the normal axial alignment of the lower extremity was restored. The restoration standard was in accordance with the uninjured side limb. The way of measurement ： the axial line from anterior superior iliac to interdigit of the first and second toe was done, then, the perpendicular distance from the center of patella to this line was calculated,and compared the data with uninjured side limb＇s. [ Result] Forty cases were followed up, from 6 months to 24 months,average 15 months, according to the Rasmussen knee score standard,24 were excellent, 11 were good, 3 were fair and 2 were poor. The satisfactory rate was 87.5 % , the restoration of knee function were close correlated with whether the line normal or not, there were abnormal lines recurrence in some cases, the main causes were： （ 1 ） Meniscus to be cut excessive to the loading redistribution in joint ; （ 2 ） The reduced articular surface collapsed, again due to the affected limb weight loading too early; （3）Fractures were tOo complicated to be compress fixed with common buttress plate, resulted in displace fracture. [Condusion] It is very important that the axial alignment of the lower extremity to be corrected during operation to the injured knee function restoration after operation, and the causes result in the axial line abnormal above-mentioned should be considered thoroughly, at the same time, the corresponding measures should be taken.

关 键 词：胫骨平台骨折 内固定 下肢力线 

分 类 号：R687.3[医药卫生—骨科学]