膝关节对角线损伤中后外侧复合体损伤一期手术疗效观察  

Observation on therapeutic effect of one-stage operation of knee joint diagonal posterolateral complex injuries

作　　者：王辉[1] 邹宏[1] 沈建平[1] 张妍[1] 李剑峰[1] 龚双全 WANG Hui;ZOU Hong;SHEN Jian-ping;ZHANG Yan;LI Jian-feng;GONG Shuang-quan(Department of Knee Joint,Mianyang Orthopaedic Hospital,Mianyang,Sichuan 621000,China)

机构地区：[1]绵阳市骨科医院膝关节科

出　　处：《中国骨与关节损伤杂志》2019年第10期1029-1032,共4页Chinese Journal of Bone and Joint Injury

摘　　要：目的探讨膝关节对角线损伤合并后外侧复合体损伤的一期手术方法及其疗效。方法回顾性分析自2013-07-2016-07采用手术治疗的11例胫骨内侧平台骨折合并后外侧复合体损伤。胫骨平台骨折按CT三柱理论分型,对零柱骨折不作骨折处理,对内侧柱骨折行切开复位内固定术。除早期1例胫骨平台内侧柱骨折合并Fanelli C型后外侧复合体损伤者未一期行后外侧复合体损伤处理外,其余B、C型后外侧复合体损伤均一期行修复重建手术。结果 11例均获得随访,随访时间平均1.5(1~3)年。1例早期只行胫骨内侧平台骨折处理而二期只行后交叉韧带重建者随访3年,出现严重膝关节内翻、过伸畸形。胫骨内侧平台骨折行切开复位内固定患者术后骨折复位、愈合良好,下肢力线无异常。末次随访时所有患者膝关节活动度恢复正常,膝关节Lysholm评分79~94分,平均91.2分。结论对于胫骨内侧平台骨折合并后外侧复合体损伤,一期修复重建手术可恢复膝关节后外侧稳定性,符合胫骨平台骨折整体治疗理念。Objective To investigate the one-stage operation approach and its therapeutic effect of knee joint diagonal and posterolateral complex injuries. Methods A retrospective analysis of 11 cases of medial tibial plateau fracture combined with posterolateral complex injuries treated by operation was performed from July 2013 to July 2016. The tibial plateau fracture was classified according to the CT three-column theory. For the zero-column fracture, no fracture treatment was performed. But for the medial column fracture, open reduction and internal fixation was performed. Except for 1 case of early column fracture of tibial plateau combined with the Fanelli type C posterolateral complex injury who was not treated in one-stage operation of posterolateral complex injury, the other B and C posterolateral complex injuries were repaired and reconstructed in one-stage.Results All 11 patients were followed up for an average of 1.5(1-3) years. There was only 1 case of medial tibial plateau fracture treated in the early stage. After two-stage operation, only patients with cruciate ligament reconstruction were followed up for 3 years and severe knee varus and overextension were observed. For patients with medial tibial plateau fractures receiving open reduction and internal fixation, their fractures were well restored and lower limb alignments were normal. At the last follow-up, all patients’ knee joint movement returned to normal and the Lysholm score of the knee was 79-94 points,with an average of 91.2 points. Conclusion For the combined posterolateral complex injuries, the primary management and reconstruction surgery can definitely restore the posterolateral stability of the knee joint, which is in line with the overall philosophy of treatment of tibial plateau fracture.

关 键 词：膝关节对角线损伤 胫骨内侧平台骨折 后外侧复合体 一期手术 

分 类 号：R687.3[医药卫生—骨科学]