交叉排钉技术对防止胫骨外侧平台骨折术后关节面塌陷的价值  

The value of cross raft screws technique to prevent postoperative collapse of tibial plateau fracture

作　　者：张玺[1] 孙杰[1] 李方国[1] 胡永成[2] 马宝通[1] 卢艳东[1] 鲁杰[1] 郭林[3] 崔猛[1] 魏学磊[1] 刘云蛟 Zhang Xi;Sun Jie;Li Fangguo;Hu Yongcheng;Ma Baotong;Lu Yandong;Lu Jie;Guo Lin;Cui Meng;Wei Xuelei;Liu Yunjiao(Department II of Knee Traumatic Orthopaedics,Tianjin Hospital,Tianfin 300211,China;Department of Bone Oncology,Tianjin Hospital,Tianjin 300211,China;Radiology Department,Tianfin Hospital,Tianjin 300211,China)

机构地区：[1]天津医院膝关节创伤骨科二病区,300211 [2]天津医院骨肿瘤科,300211 [3]天津医院影像科,300211

出　　处：《中华骨科杂志》2018年第15期897-904,共8页Chinese Journal of Orthopaedics

摘　　要：目的 探讨交叉排钉技术对防止胫骨外侧平台骨折术后关节面塌陷的价值.方法 回顾性分析2014年9月至2017年11月采用交叉排钉技术治疗14例胫骨平台骨折患者资料,男9例,女5例;年龄30～65岁,平均（44.4±1.7）岁;左膝6例,右膝8例;骨折类型按Schatzker分型：Ⅱ型10例,Ⅳ型2例,Ⅴ型1例,Ⅵ型1例.8例术前经CT测量主骨折块软骨下松质骨厚度＜4 mm,6例术中直视下证实主骨折块软骨下松质骨厚度＜4 mm.术中于外侧平台前缘附加放置1/4管型钢板,3～5枚3.5 mm皮质骨全螺纹螺钉经钢板呈“竹筏”式由前向后固定,并与外侧钢板近排螺钉组成交叉分布的空间模式固定骨折.骨折愈合后通过CT扫描查看是否出现平台塌陷.术后采用Rasmussen胫骨髁部骨折膝关节功能评分量表评价膝关节功能.结果 14例患者外侧平台前缘钢板放置操作时间18～35 min,平均（24.1±5.4） min;均获得随访,随访时间6～24个月,平均（13.8±5.1）个月.术前CT显示胫骨外侧平台塌陷高度5～21 mm,平均（8.00±1.40）mm;术后第3天,CT显示外侧关节面复位后最高点至关节水平线的垂直距离为0～2 mm,平均（0.80±0.06） mm,塌陷移位纠正,术前及术后第3天比较差异有统计学意义（P＜0.05）;患肢骨折愈合并完全负重后行CT扫描示外侧关节面复位后最高点至关节水平线的垂直距离为0～2 mm,平均（0.70±0.08）mm,未出现关节面再塌陷移位,与术后第3天比较差异无统计学意义（P=0.466）,说明在外侧平台前缘放置的钢板位置及长度适当.所有患者均获得骨性愈合,骨折平均愈合时间3.6个月,无一例发生感染、骨折不愈合、髌腱疼痛,2例皮下可触及钢板,但无不适主诉.术后Rasmussen骨折复位解剖学评分13～18分,平均16.7分,其中优8例,良6例,优良率为100％;Rasmussen膝关节功能评分18～28分,平均25.7分,其中优11例,良3例,优良率为100％.结论 交叉排钉技术可以用于治�Objective To assess the clinical value of cross raft screws technique in preventing postoperative collapse of tibial plateau fracture.Methods From September 2014 to November 2017,data of 14 patients with tibial plateau fracture who were treated by cross raft screws technique were retrospectively analyzed.There were 9 males and 5 females aged from 30-65 years old （average,44.4± 1.7 years）.There were 8 patients that the thickness of subchondral cancellous bone measured preoperatively by CT data was less than 4 mm,and 6 patients that the thickness of subchondral cancellous bone measured intraoperatively was less than 4 mm.1/4 tubular plate was placed along the anterior rim of lateral tibial plateau,and the 3.5 mm cortical bone screws were fixed as bamboo raft from anterior to posterior through the plate.The collapse of tibial plateau after surgery were measured by CT scan after union of the fracture.The function of knee was evaluated by Rasmussen Anatomical and Functional Grading.Results The time of tubular plate procedure was 18 to 35 min （average,24.1±5.4 min）.All 14 patients were successfully followed-up for 13.8±5.1 months.The height of collapse preoperatively by CT scan was 5-21 mm （average,8.00± 1.40 mm）.3 days after the operation,the height between articular line and lateral articular surface was 0-2 mm （average,0.80±0.06 mm）.Compared with CT data preoperatively,the collapse was corrected postoperatively that was proved by CT scan （P〈 0.05）.After the fracture was healed,according to CT data,the height between articular line and lateral articular surface was 0-2 mm （average,0.70±0.08 mm）.Compared with CT data postoperatively,there was no postoperative collapse happened （P=0.466）.The position and length of nails were placed appropriately.The average healing time of fracture was 3.6 months.There were no infection,nonunion and pain of tendon happened.The plate could be touched subcutaneously in 2 patients,who had no discomfort feelings.The patient＇s postoperative Rasmussen An

关 键 词：胫骨骨折 骨折固定术 内 治疗结果 

分 类 号：R687.3[医药卫生—骨科学]