胫骨外侧平台骨折合并后外侧劈裂的手术治疗  

Treatment of lateral combined with posterolateral shearing tibial plateau fractures

作　　者：冯华明[1] 易成腊[2] 蒋猛[2] 刘涛[2] 邹三明[1] 黄笃[1] 

机构地区：[1]孝感市中心医院骨科,湖北孝感432100 [2]华中科技大学同济医学院附属同济医院创伤外科,湖北武汉430030

出　　处：《生物骨科材料与临床研究》2013年第1期37-39,43,共4页Orthopaedic Biomechanics Materials and Clinical Study

摘　　要：目的探讨胫骨外侧平台并后外侧劈裂塌陷骨折的治疗方法和临床疗效。方法2008年1月～2011年12月间，收治胫骨外侧平台骨折并后外侧劈裂塌陷骨折患者8例，其中男5例，女3例，年龄33-49岁（平均38．5岁）。骨折按AO分型为B3型，CT扫描和三维重建见外侧和后外侧平台劈裂塌陷。采用前外侧联合后外侧入路治疗4例，采用外侧腓骨近端截骨入路治疗4例，骨折复位后均采用外侧和后外侧支撑钢板内固定。采用DeCoster评定标准评定骨折复位情况和HSS法行膝关节功能评定。结果术后x线片检查示所有患者均达到解剖复位，8例患者经过6-24月（平均11.8月）随访，随访3个月时x线片示骨折均已愈合，未见高度丢失，膝关节功能HSS评分为85-96分，平均89．3分。1例术后出现腓总神经麻痹，2月后神经功能恢复，无血管损伤、伤口感染和皮缘坏死等并发症。结论前外侧联合后外侧入路或外侧腓骨近端截骨入路能直视下对胫骨外侧平台并后外侧劈裂骨折进行复位和内固定，是治疗这种类型骨折较为理想的手术入路。Objective To explore the treatment of lateral combined with posterolateral shearing tibial plateau fractures and its outcome. Methods From January 2008 to December 2011, 8 cases with 5 males and 3 females of lateral combined with posterolateral shearing tibial plateau fractures were operated in our department, who aged from 33 to 49 years old （mean age was 38.5）. The lateral and posterolateral tibial plateau were found split and depression by CT scan and 3D re- construction, and all fractures were type B3 according to AO classification. Combined anterolateral and posterolateral approach were adopted for 4 cases, and fibula osteotomy approach for the others. The fragments were reduced directly and fixed with posterior antiglide buttress plate. Reductions were assessed according to the methods of DeCoster and the functional outcomes were assessed by HSS knee outcome score respectively. Results The average duration of follow-up was 14.8 （range 13 to 24） months. All fractures healed after 3 months by means of X-ray film. The average HSS knee score was 89.3 （range 85 to 96）. Except 1 patient felt common peroneal nerve paralysis after operation, but the neurological functions recovered 2 months later, no other complications such as vascular injuries, infections or skin necrosis were found postoperatively. Conclusion The approaches mentioned in this article were good clinical solutions for this kind of fracture, with the advantages of allowing excellent fracture visualization and appropriate placement of plate.

关 键 词：胫骨平台骨折 联合入路 腓骨截骨入路 内固定 

分 类 号：R687.3[医药卫生—骨科学]