最小化内固定结合Ilizarov技术在胫骨平台骨折术后膝关节内翻畸形中的应用  

Minimizd internal fixation combined with Ilizarov technique for varus deformity of knee joint after tibial plateau fracture surgery

作　　者：齐欣 徐永清 夏燊 赵泽雨 吕乾 朱跃良 Qi Xin;Xu Yongqing;Xia Shen;Zhao Zeyu;Lv Qian;Zhu Yueliang(Department of Orthopaedics,The 920th Hospital of Joint Logistics Support Force of Chinese PLA,Kunming 650032,China;Graduate School,Kunming Medical University,Kunming 650500,China)

机构地区：[1]中国人民解放军联勤保障部队第九二○医院骨科,昆明650032 [2]昆明医科大学研究生院,昆明650500

出　　处：《创伤外科杂志》2021年第2期114-119,共6页Journal of Traumatic Surgery

基　　金：云南省卫健委临床中心建设重大项目(ZX20191001)。

摘　　要：目的探讨最小化内固定结合Ilizarov技术在胫骨平台骨折术后膝关节内翻畸形中的治疗方法及临床疗效。方法回顾性分析2013年9月—2015年10月中国人民解放军联勤保障部队第九二○医院骨科收治的胫骨平台骨折术后膝关节内翻畸形患者8例,8例患者胫骨平台骨折内固定术后逐渐出现膝关节内翻畸形改变,伴屈伸障碍,行走不便。男性6例,女性2例;年龄23~50岁,平均37.1岁。道路交通伤4例,高处坠落伤1例,摔伤1例,重物砸伤2例。患者均行最小化内固定结合Ilizarov技术治疗,使用螺钉内固定后再结合Ilizarov外固定。通过比较膝内翻偏移角度、术后并发症以及应用改良Karlstrom-Olerud功能评估系统对平均功能恢复情况进行评分。结果患者获平均12.1个月(10~14个月)随访,截骨后的植骨均成骨愈合,内翻畸形改善,未出现感染及骨不连等并发症。术前评估膝内翻偏移角度(26.13±3.29)°,术后第1天再次评估偏移角度(2.13±1.83)°,矫正度数为(24.00±3.39)°,术前术后膝内翻偏移角度比较差异有统计学意义(P<0.05)。改良Karlstrom-Olerud功能评估系统评分(29.1±3.2)分,功能状态满意。结论最小化内固定结合Ilizarov技术治疗胫骨平台骨折术后膝关节内翻畸形,在此研究病例中确实避免了胫骨结节高位截骨矫形内固定等关节内截骨矫正畸形方法因内固定所带来的并发症,可以减小手术创伤,术后早期负重且矫形效果满意,膝关节功能良好,降低并发创伤性关节炎的风险,是一种有效创新的保膝治疗方式。Objective To evaluate the treatment and clinical efficacy of minimized internal fixation combined with Ilizarov technique in varus deformity of the knee joint after tibial plateau fracture surgery.Methods Eight patients with knee varus deformity after tibial plateau fractures admitted to the Department of Orthopaedics of The 920th Hospital of Joint Logistics Support Force of Chinese PLA from Sep.2013 to Oct.2015 were retrospetively analyzed.They gradually developed knee varus deformity after internal fixation,accompanied by flexion and extension disorders,and inconvenient walking.Among them,there were 6 males and 2 females;with age of 23-50(37.1 on average)years old.Causes of injury:4 cases of road traffic injuries,1 case of falling from height,1 case of falling,and 2 cases of heavy object injury.All patients were treated with minimal internal fixation combined with Ilizarov technology.The use of screw internal fixation and then combined with Ilizarov external fixation were evaluated by comparing the knee varus deviation angle,postoperative complications,and applying the improved Karlstrom-Olerud functional assessment system for the average functional recovery.Results Eight patients were followed up for an average of 12.1(10-14)months.After the osteotomy,all bone grafts healed,the varus deformity improved,and there was no complication such as infection or nonunion.Preoperative evaluation of the knee offset angle was 26.13°±3.29°,postoperative(the first day after surgery)evaluation of the offset angle was 2.13°±1.83°,the correction degree was 24.00°±3.39°,P<0.05,indicating that the difference in the angle of knee varus before and after surgery was statistically significant.The improved Karlstrom-Olerud function evaluation system obtained a score of 29.1±3.2,indicating that the functional state was satisfactory.Conclusion Minimized internal fixation combined with Ilizarov technique to treat knee varus deformity after tibial plateau fracture,can avoid the complications caused by internal fixation such as t

关 键 词：胫骨平台骨折 膝关节 内外翻畸形 内固定 ILIZAROV技术 

分 类 号：R687.3[医药卫生—骨科学]