腓骨头纵形截骨入路治疗后外侧胫骨平台骨折  

Longitudinal fibular head osteotomy approach for open reduction and internal fixation of posterolateral tibial plateau fractures

作　　者：吴彬[1] 褚风龙[1] 张钦明[1] 韩亮[1] 姜振[1] 池玉磊 王海滨[1] 孟纯阳[1] WU Bin;CHU Feng-long;ZHANG Qin-ming;HAN Liang;JIANG Zhen;CHI Yu-lei;WANG Hai-bin;MENG Chun-yang(Department of Orthopedics,Affiliated Hospital;Clinical College,Jining Medical University,Jining 272000,China)

机构地区：[1]济宁医学院附属医院骨科,山东济宁272000 [2]济宁医学院临床医学院,山东济宁272000

出　　处：《中国矫形外科杂志》2020年第18期1701-1704,共4页Orthopedic Journal of China

基　　金：山东省自然科学基金青年基金项目(编号:ZR2014CQ042);济宁医学院贺林院士基金项目(编号:JYHL2018FMS13);济宁医学院教师扶持基金项目(编号:JYFC2018FKJ048);济宁市科技局医养健康基金项目(编号:2018SMNS002)。

摘　　要：[目的]介绍腓骨头纵形截骨入路切开复位内固定治疗胫骨平台后外侧骨折的手术技术和初步临床疗效。[方法] 2012年1月~2017年12月,手术治疗21例单纯胫骨平台后外侧骨折患者。取俯卧位,行膝后外侧切口,腓骨头内1/2处进行纵向截骨,注意保护腘腓韧带、腘肌腱、股二头肌腱、外侧副韧带等结构,暴露胫骨近端后外侧,撬拨复位,植骨,"T"型钢板固定。[结果]所有患者均顺利手术,无严重并发症。末次随访时,屈膝30°、90°小腿外旋试验均为阴性,内翻应力试验为阴性,膝关节活动度(122.50±18.25)°,膝关节HSS评分平均为(85.50±9.65)分。影像方面,术后X线片显示骨折均达到解剖复位,Rasmussen放射评分平均(17.55±1.65)分。末次随访时骨折均愈合。[结论]腓骨头纵形截骨入路手术治疗胫骨平台后外侧骨折,暴露视野充分,有利于骨折的复位以及内固定的置入。[Objective] To introduce surgical technique and primary clinical outcomes of longitudinal fibular head osteotomy approach for open reduction and internal fixation(ORIF) of posterolateral tibial plateau fractures merely. [Methods] From January 2012 to December 2017, 21 patients underwent ORIF through the longitudinal fibular head osteotomy approach for posterolateral tibial plateau fractures in our hospital. Placed in prone position, a posterolateral longitude incision was made to expose the posterolateral structures. Longitudinal osteotomy of the medial a half fibular head was conducted with keeping the popliteofibular ligament, hamstring tendon, femoral biceps tendon and fibular ligament intact. Through the osteotomy gap the fractured posterolateral proximal tibia was exposed. After fractures were reduced by leveraging and embedded bone autografting, a"T"-shaped plate was used to fix the fractures firmly. [Results] All the patients had ORIF performed smoothly without serious complications. At the latest follow-up, the external rotation tests at 30° and 90° of knee flexion and varus stress test were negative in all the patients. The flexion-extension range of motion was of(122.50±18.25)°, while the HSS score was of(85.50±9.65).In term of radiographic assessment, anatomic fracture reduction was revealed by postoperative radiographs in all of them with Rasmussen imaging score of(17.55±1.65). To the latest follow up, fracture healing achieved in all the patients. [Conclusions]The longitudinal fibular head osteotomy approach provides proper visual field for open reduction and internal fixation of posterolateral tibial plateau fractures.

关 键 词：胫骨平台后外侧骨折 腓骨头纵形截骨入路 开放复位内固定 

分 类 号：R683.42[医药卫生—骨科学]