分阶段治疗伴严重软组织损伤的复杂胫骨平台骨折近期疗效  

Short-term effectiveness of staged management in treatment of complex tibial plateau fracture with severe soft tissue injury

作　　者：洪顾麒[1] 吕天润[1] 陈群[1] 宋李军[1] 黄晓文[1] 左强[1] HONG Guqi;Lü Tianrun;CHEN Qun;SONG Lijun;HUANG Xiaowen;ZUO Qiang(Department of Orthopaedics,First Affiliated Hospital of Nanjing Medical University,Nanjing Jiangsu,210029,P.R.China)

机构地区：[1]南京医科大学第一附属医院骨科,南京210029

出　　处：《中国修复重建外科杂志》2022年第10期1249-1254,共6页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：国家自然科学基金青年项目(81902206)。

摘　　要：目的探讨分阶段治疗伴严重软组织损伤的复杂胫骨平台骨折近期疗效。方法回顾性分析2017年7月—2021年3月收治且符合选择标准的12例伴严重软组织损伤的复杂胫骨平台骨折患者临床资料。男7例,女5例;年龄33~58岁,平均43.1岁。致伤原因均为交通事故伤,受伤后24 h内入院。胫骨平台骨折均为闭合骨折,按照Schatzker分型标准:Ⅳ型3例,Ⅴ型4例,Ⅵ型5例。软组织损伤Tscherne分级:Ⅱ级4例,Ⅲ级8例。治疗分为三阶段,第1阶段急诊行跨关节骨折外固定支架固定术,第2阶段行二期骨折复位内固定并植入骨水泥填充骨缺损,第3阶段行三期植骨术修复;术后均及早行功能锻炼。结果三期手术后均无神经损伤症状,切口均Ⅰ期愈合,未出现切口感染、坏死等并发症。患者均获随访,随访时间6~32个月,平均16.9个月。术后X线片复查示骨折均达解剖复位,随访期间无明显复位丢失及内固定物松动、断裂,关节面无塌陷;骨折均愈合,愈合时间14~20周,平均17.6周。植骨术后即刻胫骨平台后倾角为(9.7±2.3)°、内翻角为(3.9±1.9)°,术后6个月时分别为(8.5±2.9)°、(4.3±1.9)°,两时间点间比较差异无统计学意义(t=0.658,P=0.514;t=-1.167,P=0.103)。末次随访时,美国特种外科医院(HSS)评分为85~96分,平均91.2分;膝关节活动度为110°~135°,平均120.9°。结论分阶段治疗伴严重软组织损伤的复杂胫骨平台骨折可获得满意近期疗效,远期疗效需进一步随访明确。Objective To evaluate short-term effectiveness of staged management for complex tibial plateau fracture with severe soft tissue injury.Methods A clinical data of 12 patients with complex tibial plateau fractures and severe soft tissue injuries between July 2017 and March 2021 and met the selection criteria was retrospectively analyzed.There were 7 males and 5 females with an average age of 43.1 years(range,33-58 years).All patients were traffic accident injuries and admitted to hospital within 24 hours after injury.The tibial plateau fractures were closed fractures.According to the Schatzker classification standard,the fractures were rated as typeⅣin 3 cases,typeⅤin 4 cases,and typeⅥin5 cases.According to the Tscherne classification standard,the soft tissue injuries were rated as gradeⅡin 4 cases and gradeⅢin 8 cases.The treatment of all patients was divided into 3 stages.In the first stage,emergency trans-articular fracture fixation with external fixator was performed;in the second stage,the fracture reduction and internal fixation were performed and bone cement was implanted to fill the bone defect;in the third stage,the bone cement was removed and the bone graft was performed to repair defect.All patients performed joint function exercise after operation as early as possible.Results There was no neurological symptom after all staged managements,the incisions healed by first intention,and no complications such as incision infection or necrosis occurred.All patients were followed up 6-32 months(mean,16.9months).The fractures were all anatomical reduction confirmed by the X-ray films after operation.During follow-up,there was no obvious loss of reduction,loosening and rupture of internal fixator,or collapse of the articular surface.All fractures healed after 14-20 weeks(mean,17.6 weeks).The posterior slope angle of the tibial plateau was(9.7±2.3)°and the varus angle was(3.9±1.9)°immediately after bone grafting,and were(8.5±2.9)°and(4.3±1.9)°respectively at 6 months after operation.There was no s

关 键 词：胫骨平台骨折 软组织损伤 分阶段治疗 内固定 近期疗效 

分 类 号：R687.3[医药卫生—骨科学]