经腓骨头截骨入路内固定治疗胫骨平台后外侧骨折的临床疗效观察  

Clinical observation of internal fixation of posterolateral tibial plateau fractures through fibular head osteotomy

作　　者：张斌[1] 黄奇[1] 李浪[1] 谢林[1] 李强[1] 高峰[1] 

机构地区：[1]西藏自治区人民政府驻成都办事处医院,四川610041

出　　处：《中国骨与关节杂志》2015年第6期469-472,共4页Chinese Journal of Bone and Joint

摘　　要：目的：探讨经腓骨头截骨入路治疗胫骨平台后外侧骨折的近期临床疗效。方法2011年8月至2014年1月，我院采用经腓骨头截骨入路内固定治疗胫骨平台后外侧骨折的患者14例。其中男6例，女8例；年龄28～72岁，平均34.2岁。Schatzker 胫骨平台骨折分型：I 型4例、II 型8例、III 型2例。均为新鲜闭合性骨折，10例合并同侧腓骨头骨折，均未合并血管、神经损伤。记录手术时间、出血量、并发症，所有患者术后均行 Rasmussen 评分评估骨折复位效果，膝关节活动度、HSS 评分评估膝关节功能。结果本组14例平均随访21.4（4～40）个月。手术时间60～95 min，平均75 min。术中出血量60～300 ml，平均100 ml。所有患者均获得骨折解剖复位。Rasmussen 骨折复位评分14～18分，平均16.5分。所有患者均无神经血管损伤，伤口均 I /甲愈合。随访期间均未出现复位的关节面再次塌陷，以及骨折不愈合、延迟愈合及感染并发症。膝关节平均活动范围：伸-5°～0°、屈膝80°～135°，平均活动范围126.4°。HSS 膝关节功能评分为65～98分，平均90分。结论经腓骨头截骨治疗胫骨平台后外侧骨折能充分暴露、满意复位及固定，术后骨折愈合及功能恢复良好，临床效果满意。Objective To evaluate short-term outcomes of internal ifxation of posterolateral tibial plateau fractures through ifbular head osteotomy.Methods From August 2011 to January 2014, 14 patients with posterolateral tibial plateau fractures were treated through fibula osteotomy. There were 6 males and 8 females, aging from 28 to 72 years. The average age was 34.2 years old. According to the Schatzker classiifcation, 4 cases were of type I, 8 cases type II and 2 cases type III. All patients were of fresh closed fractures. Ten cases were combined with ipsilateral fibular head fracture. No vascular or nerve injury exited. Operation time, blood loss, postoperative complications were analyzed in all patients. Rasmussen score was applied to evaluate the fracture reduction and the range of motion of the knee. Hospital for Special Surgery （ HSS ） knee score was applied to assess the functions of involved knee. Results All patients were followed up. The average follow-up period was 21.4 months （ range： 4 to 40 months ）. The mean operative time was 75 minutes （ range： 60-95 minutes ）. The average blood loss was 100ml （ range： 60- 300 ml ）. Anatomical reduction was achieved in all patients. The average Rasmussen score was 16.5 points （ range： 14-18 points ）. There was neither neurovascular injury nor wound infection. All wounds were of I / A healing. During the follow-up, no reduction loss, nonunion or delayed union of fractures, or complications occurred. The average range of motion of the knee was 126.4° （ extension -5°-0, lfexion 80-135° ）. The average HSS knee score was 90 points （ range：65-98 points ）.Conclusions Internal ifxation of posterolateral tibial plateau fractures through ifbular head osteotomy can obtain good clinical outcomes with sufifcient exposure, ifne reduction and ifxation, and satisfactory fracture healing and function recovery.

关 键 词：胫骨骨折 骨折固定术 内 截骨术 骨折 创伤和损伤 

分 类 号：R687.3[医药卫生—骨科学]