复杂Schatzker Ⅳ型胫骨平台骨折入路选择的探讨  

Study on surgical approaches for the complex Schatzker IV tibial plateau fractures

作　　者：李黎[1] 方诗元 王叙进 徐磊[1] 徐玮 夏睿 杨家赵 刘雷[1] 谢凯[1] Li Li;Fang Shiyuan;Wang Xujin;Xu Lei;Xu Wei;Xia Rui;Yang Jiazhao;Liu Lei;Xie Kai(Department of Orthopaedics,the First Affiliated Hospital of USTC,Division of Life Sciences and Medicine,University of Science and Technology of China,Hefei 230001,China)

机构地区：[1]中国科学技术大学附属第一医院(安徽省立医院)创伤骨科

出　　处：《中国临床保健杂志》2019年第6期801-804,共4页Chinese Journal of Clinical Healthcare

基　　金：安徽省自然科学基金(1908085QH359)

摘　　要：目的探讨伴后外侧平台塌陷的SchatzkerⅣ型胫骨平台骨折的手术入路选择和临床疗效。方法选取伴后外侧平台塌陷的Schatzker IV型胫骨平台骨折46例。依据后外侧平台塌陷的位置制定个性化的手术入路,其中前外侧联合后内侧入路17例(A组),外侧腓骨小头截骨联合后内侧入路8例(B组),后内侧倒"L"入路21例(C组)。记录手术时间、出血量、并发症及Rasmussen影像学评分、美国特种外科医院(HSS)评分、膝关节活动度、胫骨平台角及内侧后倾角。结果 46例患者随访12~28个月,平均时间16个月;三组不同手术入路的手术时间和出血量差异无统计学意义;术后切口均Ⅰ期愈合,3例出现小腿肌间静脉血栓;B组出现1例腓总神经损伤,3周后恢复,1例腓骨截骨处出现不愈合;术后12个月Rasmussen评分为16.3分(范围:14~18分),优37例,良6例,可2例,差1例;术后12个月HSS评分平均88.6分(范围:85~94分),优33例,良8例,可4例,差1例。本组终末随访膝关节屈伸活动度为103°~120°,平均115.5°。术后即刻和终末随访胫骨平台内翻角和胫骨内侧平台后倾角差异无统计学意义。结论伴后外侧平台塌陷的Schatzker IV型胫骨平台骨折可依据后外侧塌陷骨块的中心点位置来选择合理的手术入路,后外侧塌陷的骨块往往是影响内侧平台劈裂骨块复位的关键点。Objective To explore the surgical approaches and clinical outcomes of Schatzker IV tibial plateau fractures with posterolateral plateau collapse.Methods 46 cases of Schatzker IV tibial plateau fractures with posterolateral platform collapsed were treated.The choice of surgical approaches were based on the location of the posterolateral platform collapse.17 cases were treated with anterolateral approach(Group A),and the other group were treated with lateral fibular osteotomy combined with medial posterior approach(Group B),and 21 cases were treated with reverse "L" approach(Group C).The data including operation time,blood loss,complications and Rasmussen imaging score,HSS score,knee joint activity,tibial plateau angle(TPA) and medial posterior angle(Medial PA) were recorded.Results 46 cases were followed up for 16 months(12-28 months).There was no significant difference in operative time and blood loss between the three groups.The incisions healed at stage I.There were 3 patients with venous thrombosis of the leg muscles.1 case with iatrogenic common peroneal nerve injury(recovered after 3 weeks) and 1 patient with fibular osteotomy nonunion occurred in group B.The Rasmussen score was 16.3(14-18) at the end of the operation,and the results were excellent in 37 cases,good in 6 cases,fail in 2 cases,and poor in 1 case.The average score of HSS was 88.6(85-94) after operation in the last 12 months,excellent in 33 cases,good in 8 cases,fair in 4 cases and poor in 1 case.At the end of the follow-up,range of motion of the knee joint was 115.5 degrees(103-120 degrees).There was no significant difference between TPA and MPA in immediate and final follow-up.Conclusion The surgical approach of Schatzker IV tibial plateau fracture with posterolateral platform collapsed should be determined according to the location of the central position of the posterolateral bone graft.The posterolateral bone block is the key point for the reduction of the medial plate split.

关 键 词：胫骨骨折 骨折脱位 骨折固定术 内 修复外科手术 治疗结果 

分 类 号：R68[医药卫生—骨科学]