累及后方的复杂胫骨平台骨折影像学研究及治疗策略  

Radiological study and treatment strategies for complex tibial plateau fracture involving posterior fragment

作　　者：水小龙[1] 翁益民[1] 应晓洲[1] 陈华[1] 冯永增[1] 郭晓山[1] 孔建中[1] 

机构地区：[1]温州医科大学附属第二医院骨科,325027

出　　处：《中华创伤杂志》2014年第11期1137-1140,共4页Chinese Journal of Trauma

摘　　要：目的 分析累及后方的复杂胫骨平台骨折的影像学特征,探讨此类骨折的手术治疗策略.方法 纳入2009年2月-2014年2月收治31例累及后方的复杂胫骨平台骨折患者,其中男19例,女12例;年龄24～72岁,平均42.5岁.致伤原因：交通伤13例,高处坠落伤9例,摔伤5例,压砸伤4例.按Schatzker分型：Ⅴ型16例,Ⅵ型15例.均为三柱骨折.根据X线片及CT表现,将患者分为后内侧骨折后方移位不明显组（A组,22例）和后内侧骨折后方移位明显组（B组,9例）.影像学检查分析骨折大小、骨折线的角度等情况.A组采用前方入路复位内固定,B组采用前外侧加后内侧入路复位内固定.按Rasmussen影像学评分及Rasmussen膝关节功能评分评价治疗效果.结果 31例患者均Ⅰ期顺利完成手术,手术时间A组80～120min,平均98min,B组110～165min,平均110mm,两组手术总的平均时间为105min.随访6～48个月,平均21.5个月.Rasmussen影像学评分,A组优良率为86％,B组为78％,总的优良率达84％;根据Rasmussen功能评分,A组优良率为91％,B组为78％,总的优良率达87％.结论 累及后方的复杂胫骨平台骨折,根据后方平台特异性的影像学特征及后内侧骨折后方移位程度可以程序化应用前方入路或前外加后内入路进行治疗,并可同时处理合并的关节内软组织损伤,临床疗效良好.Objective To investigate radiological characteristics of the posterior tibial plateau fracture and operative treatments for the fracture.Methods Thirty-one cases of posterior tibial plateau fracture treated between February 2009 and February 2014 were enrolled.There were 19 men and 12 women aged 24-72 years （mean,42.5 years）.Injury arose from traffic accidents （13 cases）,falls from a height （9 cases）,fall on the ground （5 cases）,and crash （4 cases）.Type Ⅴ in 15 cases and type Ⅵ in 15 cases were classified by the Schatzker classification.Meanwhile,all fractures were identified as three-column pattern.According to the X-ray and CT manifestations of fracture displacement,the cases with minor displacement were grouped as Group A （22 cases） and the cases with major displacement group as Group B （9 cases）.Depending on the radiographic characteristics of fracture size and angle off fracture line,anterior approach for reduction and fixation was performed in Group A and combined anterolateral and posteromedial approaches in Group B.Radiographic and functional outcomes were evaluated using the Rasmussen score.Results All cases underwent one-stage surgery uneventfully.Operation time was 80-120 minutes （mean,98 minutes） in group A and was 110-165 minutes （mean,110 minutes） in Group B.Mean total operation time was 105 minutes.Period of follow-up was 6-48 months （mean,21.5 months）.Rasmussen radiographic results showed total excellent to good rate of 84% with 86% in Group A and 78% in Group B respectively.Rasmussen functional results showed total excellent to good rate of 87% with 91% in Group A and 78% in Group B respectively.Conclusions Anterior approach or anterolateral approach combined with posteromedial approach for reduction and internal fixation is developed according the radiographic findings and degree of fracture displacement.Clinical outcome is good and associated intraarticular soft tissue injury can be managed concurrently.

关 键 词：胫骨骨折 骨折固定术 内 影像 

分 类 号：R687.3[医药卫生—骨科学]