胫骨外髁非负重区截骨治疗胫骨平台后外侧髁骨折  

Non-weight-bearing area osteotomy of lateral tibial condyle in treating posterior-lateral condyle fracture of tibial plateau

作　　者：霍永峰[1] 殷照阳[1] 徐刚[1] 顾光学[1] 厉雷明[1] 于吉文[1] 孙晓[1] 

机构地区：[1]江苏省连云港市第一人民医院创伤骨科,222002

出　　处：《重庆医学》2018年第7期919-922,925,共5页Chongqing medicine

基　　金：江苏省连云港市卫生科研项目(201608)

摘　　要：目的探讨胫骨外髁前外侧非负重区截骨治疗胫骨平台后外侧髁骨折的临床疗效。方法对该院2012年12月至2015年12月采用胫骨外髁前外侧截骨治疗的24例胫骨平台后外侧髁骨折患者进行回顾性分析,男15例,女9例;年龄26~59岁,平均(42.2±9.2)岁。骨折Schatker分型Ⅱ型16例,Ⅴ型3例,Ⅵ型5例;所有24例采用胫骨外髁前外侧入路进行手术治疗,术中经胫骨外髁非负重区截骨显露复位后外侧骨折并使用外侧排筏钢板固定。末次随访时根据美国特种外科医院(HSS)膝关节评分系统评定膝关节功能恢复情况。结果 24例患者术后获平均13.1个月(12~24)个月随访。术后即刻骨折复位质量Rasmussen评分平均(17.3±0.8)分;其中优19例,良5例,优良率为100%。24例无切口感染,无内固定松动或断裂,X线片示骨折均获愈合,愈合时间平均为(13.1±1.1)周。未见血管、神经损伤等手术相关并发症发生,2例术后出现后侧切口皮缘表浅的小面积坏死,经换药愈合。末次随访时HSS膝关节评分平均为(93.0±6.4)分,其中优19例,良4例,可1例,优良率为95.8%。结论对于胫骨平台后外侧髁骨折患者,胫骨外髁非负重区截骨入路允许足够的空间对骨折进行直接显露及操作,联合外侧排筏锁定钢板固定骨折可靠,手术体位摆放方便,术后功能恢复良好,并发症少,疗效满意。Objective To explore the clinical curative effects of non-weight-bearing area osteotomy of anterior lateral tibial condyle in treating posterior-lateral condyle fracture of tibial plateau.Methods A retrospective analysis was carried out on 24 cases of posterior-lateral condyle fracture of tibial plateau treated by osteotomy of anterior lateral tibial condyle in this hospital from December 2012 to December 2015,including 15 males and 9 females,aged 26-59 years old with an average age of 42.2 years old.Fracture Schatker classification：type II in 16 cases,type V in 3 cases and type VI in 5 cases.All 24 cases adopted surgical treatment via the approach of anterior lateral tibial condyle.During operation,the non-bearing area of lateral tibial condyle was cut to expose and reset the posterior-lateral fractured condyle and fix it with lateral raft steel plate.At the time of last follow-up,the recovery of the knee joint function was evaluated according to the knee scoring system of Hospital for Special Surgery（HSS）in USA.Results Twenty-four patients were postoperatively followed up for 12-24 months,with an average of 13.1 months.The Rasmussen score for the postoperative immediate fracture reduction quality averaged（17.3±0.8）points;there were 19 cases of excellent results and 5 cases of good results,with the excellent and good rate of 100%.Twenty-four cases had no incision infection,no internal fixation loosening or breakage.The X ray film showed that the fracture got healing,and the average healing time was（13.1±1.1）weeks（12-15 weeks）.No surgery related complications including blood vessel and nerve damage occurred;2 cases appeared small area of superficial necrosis at the edge of the posterior incision,which was healed after dressing.At the last follow-up,the HSS knee score was（93.0±6.4）points,excellent in 19 cases,good in 4 cases,and fair in 1 case,with the excellent and good rate of95.8%.Conclusion For the patients with posterior-lateral condyle fracture of tibial platform,non-weight-bearing a

关 键 词：胫骨骨折 骨折固定 内 后外侧 钢板 

分 类 号：R683.42[医药卫生—骨科学]