经前内及前外侧联合入路治疗复杂过伸型胫骨平台骨折  

Treatment of complex hyperextension tibial plateau fractures via combined anteromedial and anterolateral approaches

作　　者：洪顾麒[1] 吕天润[1] 宋李军[1] Hong Guqi;Lyu Tianrun;Song Lijun(Department of Orthopaedics,The First Affiliated Hospital to Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院骨科,210029

出　　处：《中华创伤骨科杂志》2020年第8期687-692,共6页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨联合入路治疗复杂过伸型胫骨平台骨折的效果。方法回顾性分析2013年1月至2018年7月南京医科大学第一附属医院骨科采用手术治疗的11例复杂过伸型胫骨平台骨折患者资料。男7例,女4例;年龄23~62岁,平均41.5岁。骨折均累及双髁,6例为过伸内翻型损伤,3例为单纯过伸型损伤(冠状位无明显内外翻畸形),2例为过伸外翻型损伤。经前内及前外侧入路行手术治疗,术后患肢以膝关节支具保护。术后定期门诊复查,末次随访时使用美国特种外科医院(HSS)膝关节功能评分标准评定膝关节功能。根据X线片评定胫骨平台后倾角及内翻角的改变。结果11例患者术后均无神经症状,伤口均一期愈合。所有患者术后获6~28个月(平均18.5个月)随访。术后X线片示所有患者骨折均解剖复位,术后定期复查均未见复位丢失及内固定物松动、断裂。骨折愈合时间为10~16周,平均12.5周。术后即刻后倾角为12.8°±1.6°,内翻角为3.8°±1.1°;术后6个月时后倾角为11.9°±1.7°,内翻角为3.6°±1.8°,以上指标术后即刻与术后6个月比较差异均无统计学意义(P>0.05)。末次随访时HSS评分85~96分(平均90.4分),膝关节屈曲120°~140°(平均127.2°),膝关节伸直-5°~5°(平均伸直0°)。结论采用联合入路的手术方法治疗累及双髁的复杂过伸型胫骨平台骨折短期随访效果满意,但缺乏远期随访结果,值得进一步关注总结。另外过伸型胫骨平台骨折合并血管、神经等损伤几率较高,临床上对这类软组织损伤造成的影响不可忽视。Objective To evaluate the outcomes of complex hyperextension tibial plateau fractures treated via combined anteromedial and anterolateral approaches.Methods From January 2013 through July 2018,11 complex hyperextension tibial plateau fractures were surgically treated at Department of Orthopaedics,The First Affiliated Hospital to Nanjing Medical University.The patients were 7 males and 4 females,aged from 23 to 62 years(average,41.5 years).All the fractures affected both tibial condyles.Of them,6 had hyperextension varus injury,3 simple hyperextension injury without varus or valgus at the coronal view,and 2 hyperextension valgus injury.All their fractures were exposed and reset via combined anteromedial and anterolateral approaches.After surgery,orthosis of the knee joint was used to protect the affected limbs and the patients were followed up regularly at the outpatients department.At the final follow-up,the knee function was evaluated using The Hospital for Special Surgery(HSS)scoring system while the posterior slope angle and the tibial plateau angle were assessed on their X-ray films.Results No neurological symptoms were observed in the 11 patients whose wounds healed by the first intention.They were followed up from 6 to 28 months(average,18.5 months).All the fractures obtained anatomical reduction by the X-ray after operation.Regular follow-ups showed no reduction loss,implants loosening or breakage.The fractures united after 10 to 16 weeks(average,12.5 weeks).At immediate postoperation,the posterior slope angle was 12.8°±1.6°and the tibial plateau angle 3.8°±1.1°;at 6 months postoperation,the posterior slope angle was 11.9°±1.7°and the tibial plateau angle 3.6°±1.8°.There were no significant differences between immediate postoperation and 6 months postoperation in the above indexes(P>0.05).At the final follow-up,the HSS scores ranged from 85 to 96(mean,90.4),the knee flexion from 120°to 140°(mean,127.2°),and the knee extension from-5°to 5°(mean,0°).Conclusions Surgery via combined anterome

关 键 词：膝关节 骨折固定术 内 软组织损伤 胫骨平台骨折 过伸型 联合入路 

分 类 号：R687.3[医药卫生—骨科学]