超近端胫骨平台双髁骨折的临床特点及治疗策略  

Clinical characteristic and therapeutic strategy of the super-proximal bicondylartibial plateau fracture

作　　者：伍凯[1] 黄建华[1] 林健[1] W王秋根 

机构地区：[1]上海交通大学附属第一人民医院创伤骨科,上海市创伤急救中心,200620

出　　处：《中华骨科杂志》2014年第4期441-447,共7页Chinese Journal of Orthopaedics

摘　　要：目的探讨超近端胫骨平台双髁骨折的临床特点及治疗策略。方法回顾性分析2007年6月至2012年10月治疗8例超近端胫骨平台双髁骨折患者资料，男6例，女2例；年龄28-56岁，平均40．8岁。患者术前均常规行三维CT扫描以了解骨折类型及主要骨折块的空间位置。在等待7-14d，待软组织条件改善后接受切开复位内固定术。对后柱移位不明显者采用前外侧联合前内侧切口，需处理后柱的患者则采用前外侧切口联合后内侧切口，其中6例患者接受自体或者异体骨植骨。侧副韧带损伤可1期修复；而十字韧带损伤术中不常规修复，术后给予6周支具或石膏外固定。结果8例患者术后获得12-26个月的随访，平均18．6个月。所有患者末次随访时均获骨性愈合，愈合时间为18-26周，平均21．5周。X线片示膝关节面平整，关节力线良好。美国纽约特种外科医院（HSS）评分为56-90分，平均78．12分，其中优3例，良3例，可1例，差1例；优良率为75％（6／8）。Lysholm评分为58-91分，平均81．37分，其中优4例，可3例，差1例；优良率为50％（4／8）。结论超近端胫骨平台双髁骨折是一种以胫骨前平台骨折为主，多伴有膝关节后脱位及血管、神经损伤的特殊骨折，术前常规行三维CT扫描，术中注意评估膝关节稳定性，恢复膝关节的力线及关节面平整，早期支具保护下功能锻炼可获得较好疗效。Objective To discuss the clinical character and the therapeutic strategy of the super-proximal bicondylartibi-al plateau fracture. Methods A review of 8 patients with an average age of 40.8 years old （range, 28-56 years; 6 males, 2 fe-males） surgically treated from June 2007 to October 2012 was conducted. Conventional pre-operative three-dimensional CT scans were used to clarify the types of fractures and the locations of major displaced bone fragments. All patients received open reduc- tion and internal fixation 7-14 days after injury for recovery of soft tissue. Anterolateral incision combined anteromedial incision was made on those with limited posterior column shift. Otherwise anterolateral incision combined posteromedial might be better for those with obvious displacement. Six of the patients were implanted autograft bone or allograft bone. The collateral ligaments could be repaired in one stage, but a routine repair of cruciate ligaments was not concerned, and an immobilization for six weeks with a plaster or a brace should be followed. Results All cases were followed-up for 12 to 26 months （median follow-up period, 18.6 months）. All the fractures in the series achieved bone union at or before the last follow-up, and the healing time ranged from 18 to 26 weeks （median healing period, 21.5 weeks）. The X-rays showed the smooth surface and good alignment of knee joint at the last follow-up. The median hospital for special surgery knee score （HSS） was 78.12 （range, 56-90）, with 3 excellent cases, 3 good cas- es, 1 fair cases and 1 poor case; the excellent and good rate was 75% （6 of 8）. The median Lysholm score was 81.37 （range, 58- 91）, with 4 good cases, 3 fair cases and 1 poor case; the excellent and good rate was 50% （4 of 8）. Conclusion Super-proximal bicondylartibial plateau fracture is a special fracture type accompanied with posterior dislocation of knee, which is predominantly presented as an anterior plateau fracture. And injuries of blood vessels and nerve are common.

关 键 词：胫骨骨折 骨折固定术 内 内固定器 

分 类 号：R687.3[医药卫生—骨科学]