胫骨平台后外侧髁骨折腓骨小头上入路设计及临床应用  

Design and clinical application of the superior of fibular head approach

作　　者：储旭东[1] 朱建平[1] 蔡福金[1] 刘晓晖[1] 周敏[1] 

机构地区：[1]解放军第一0一医院骨科,无锡214044

出　　处：《中华骨科杂志》2012年第12期1145-1150,共6页Chinese Journal of Orthopaedics

摘　　要：目的通过尸体解剖设计腓骨小头上人路，并用于治疗胫骨平台后外侧髁骨折，探讨其临床应用的可行性及优缺点。方法解剖冰冻成人膝关节10个，观察膝关节外侧重要结构的相关性，膝关节屈曲过程对外侧副韧带紧张度的影响，测量腓骨小头关节面上缘至胫骨平台关节面外侧缘距离（OA）、外侧副韧带与关节面水平交点至胫骨平台关节面外侧缘距离（OB）。根据解剖学测量设计腓骨小头上入路，并临床应用于胫骨平台后外侧髁骨折患者12例。男8例，女4例；年龄28-52岁，平均41．5岁。通过腓骨小头上人路行骨折复位及内固定，评估其近期临床疗效。结果OA为9．43～14．92mm，平均（12．97±1．83）mm。当膝关节在O°位时外侧副韧带紧张，OB为（4．87±0．33）mm；屈膝时OB随外侧副韧带松弛而增大，屈膝60°时最为松弛，向后侧牵拉外侧副韧带同时稍内旋胫骨可完整显露后外侧髁。临床应用病例术后随防6～24个月，平均18个月。骨愈合时间8～12周，平均10．2周。Rasmussen膝关节功能恢复评分为优10例、良2例。无肢体麻木、关节不稳及内固定松动等并发症。结论经腓骨小头上入路治疗胫骨后外侧髁骨折可行，操作简单安全。Objective To design an approach above the fibular head for treating posterolateral tibial plateau fracture, and to investigate its feasibility, advantages and disadvantages in clinical application. Methods Ten frozen adult cadaveric knees were dissected to observe the correlation of the important lateral structures and effect of knee flexion on tensity of the lateral collateral ligament. The distance （OA） from superior border of facies articularis capitis fibulae to lateral edge of articular surface of tibial plateau and the distance （OB） from the cross point of lateral collateral ligament and facies articularis capitis fibulae level to lateral edge of articular surface of tibial plateau were measured. According to the anatomic measurement resuits, the approach above the fibular head was designed. Then 12 patients with posterolateral tibial plateau fracture were treated through this approach, and the short-term clinical results were evaluated. Results The value of OA ranged from 9.43 to 14.92 mm （average, 12.97±1.83 ram）. At 0° of genuflex, the lateral collateral ligament was tense and the average value of OB was 4.87±0.33 ram. During the course of genuflex, the lateral collateral ligament got loose following which the value of OB became larger. At 60° of genuflex, the lateral collateral ligament was most loose, and the posterolateral tibial plateau could be exposed completely by drawing posterolaterally lateral collateral ligament and rotating medially tibia. All patients were followed up for 6 to 24 months （average, 18 months）. The average bone healing time was 10.2 weeks （8 to 12 weeks）. According to Rasmussen＇s knee functional score system, the results were excellent in 10 cases and good in 2 cases. No complications occurred, such as numbness of limbs, instability of the knee and internal fixation loosening. Conclusion The approach above the fibular head is feasible, simple and safe for treating posterolateral tibial plateau fracture.

关 键 词：胫骨骨折 解剖学 局部 骨折固定术 内 

分 类 号：R687.3[医药卫生—骨科学]