经腓骨小头上入路治疗胫骨平台后外侧髁骨折的临床研究  

CLINICAL STUDY ON TREATMENT OF POSTEROLATERAL FRACTURE OF TIBIAL PLATEAU VIA SUPERIOR FIBULAR HEAD APPROACH

作　　者：储旭东[1] 刘晓晖[1] 陈伟南[1] 高建明[1] 骆宇春[1] 朱建平[1] 蔡福金[1] 周敏[1] 

机构地区：[1]解放军第101医院骨科,江苏无锡214044

出　　处：《中国修复重建外科杂志》2013年第2期155-159,共5页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：江苏大学医学临床科技发展基金资助项目(JLY20120140)~~

摘　　要：目的探讨经腓骨小头上入路治疗胫骨平台后外侧髁骨折的疗效。方法 2010年6月-2012年2月,收治20例胫骨平台后外侧髁骨折患者。男12例,女8例;年龄28～58岁,平均42.2岁。致伤原因:交通事故伤14例,高处坠落伤4例,扭伤2例。均为闭合性骨折。单纯后外侧髁骨折1例,后外侧髁骨折合并其他部位骨折19例。合并外侧半月板损伤5例,内侧半月板损伤2例,前交叉韧带损伤1例。患者受伤至入院时间90 min～32 h,中位时间4.5 h。入院至手术时间5～12 d,平均7.8 d。取腓骨小头上入路,骨折复位Pilon钢板固定;一期处理合并骨折及半月板损伤。结果术后切口均Ⅰ期愈合。患者均获随访,随防时间6～26个月,平均19.1个月。术后无肢体麻木、关节不稳等并发症发生。X线片复查示,骨折均愈合,愈合时间8～12周,平均10.2周;随访期间均无内固定物松动及关节面丢失发生。末次随访时按Rasmussen膝关节功能评分标准,获18～30分,平均27.9分;其中优16例,良3例,中1例,优良率95%。结论经腓骨小头上入路治疗胫骨平台后外侧髁骨折手术操作简便,安全有效,可获得较好疗效。Objective To observe the effectiveness of the superior fibular head approach for the treatment of posterolateral fracture of the tibial plateau. Methods Between June 2010 and February 2012, 20 cases of posterolateral fracture of the tibial plateau were treated through superior fibular head approach, including 1 case of simple posterolateral fracture of the tibial plateau and 19 cases of posterolateral fracture of the tibial plateau with other fractures. There were 12 males and 8 females with an average age of 42.2 years （range, 28-58 years）. All patients had closed fractures. Fracture was caused by traffic accident in 14 cases, by falling from height in 4 cases, and by twist injury in 2 cases. Associated injuries included lateral meniscus injury in 5 cases, medial meniscus injury in 2 cases, and anterior cruciate ligament injury in 1 case. The time from injury to admission ranged from 90 minutes to 32 hours （mean, 4.5 hours）, and the time from admission to operation was 5-12 days （mean, 7.8 days）. All cases underwent fracture reduction and fixation with Pilon plates through the superior fibular head approach, and associated fracture and meniscal injury were treated. Results All incisions healed by first intention, and no numbness or articular instability occurred. All patients were followed up 6-26 months （mean, 19.1 months）. The average fracture healing time was 10.2 weeks （range, 8-12 weeks）. During following-up, no related complication of fixation loosening or articular surface loss occurred. According to Rasmussen knee score criteria at last follow-up, the score was 18-30 （mean, 27.9）; 16 cases were graded as excellent, 3 cases as good, and 1 case as fair, with an excellent and good rate of 95%. Conclusion The superior fibular head approach for the treatment of posterolateral fracture of the tibial plateau is simple, safe, and effective, and can achieve a good surgical outcome.

关 键 词：胫骨平台后外侧髁骨折 腓骨小头上入路 内固定 

分 类 号：R687.3[医药卫生—骨科学]