微创复位联合Jail螺钉技术固定治疗孤立性胫骨平台后外侧塌陷骨折  

Treatment of Isolated Posterolateral Tibial Plateau Collapse Fractures With Minimally Invasive Reduction and Jail Screw Fixation Technique

作　　者：孔祥如 姜伟 单宇宙 孙健宁 刘旭 钱玉 杨春 杨太明 Kong Xiangru;Jiang Wei;Shan Yuzhou(Department of Orthopedics,Suqian Hospital Affiliated to Xuzhou Medical University,Suqian Hospital of Nanjing Drum Tower Hospital Group,Suqian 223800,China)

机构地区：[1]徐州医科大学附属宿迁医院南京鼓楼医院集团宿迁医院骨科,宿迁223800

出　　处：《中国微创外科杂志》2022年第12期945-951,共7页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨经骨隧道微创复位联合Jail螺钉技术固定治疗孤立性胫骨平台后外侧塌陷骨折的临床疗效。方法2016年10月~2020年10月我科对25例孤立性胫骨平台后外侧塌陷骨折应用Mimics20.0软件行术前规划,术中经胫骨骨隧道空心顶棒锤击复位胫骨平台后外侧塌陷骨折,Jail螺钉固定。比较术前、术后第2天及术后1年胫骨平台关节面塌陷距离、胫骨平台后倾角(posterior slope angle,PSA)及Rasmussen解剖评分,术后第2天、术后1年采用美国特种外科医院(Hospital for Special Surgery,HSS)评分评价膝关节功能。结果手术时间35~60 min,(55.6±4.4)min。术中出血量10~50 ml,(20.6±9.2)ml。骨折均Ⅰ期临床愈合,愈合时间8~12周,(10.5±1.3)周。25例随访12~36个月,(16.5±4.1)月。胫骨平台关节面塌陷距离由术前(9.2±2.2)mm恢复至术后第2天及术后1年(1.0±0.4)、(1.1±0.1)mm(均P=0.000);PSA由术前21.2°±2.1°恢复至术后第2天8.9°±0.9°分和术后1年9.2°±0.6°(均P=0.000);Rasmussen解剖评分由术前(7.8±1.8)分恢复至术后第2天(17.1±1.0)分和术后1年(16.3±0.7)分(均P=0.000)。与术后第2天比较,术后1年胫骨平台关节面塌陷距离、胫骨平台PSA及Rasmussen解剖评分差异无统计学意义(均P>0.05)。术后1年HSS评分(94.8±3.2)分,明显高于术后第2天(76.8±3.5)分(t=18.713,P=0.000)。结论经胫骨隧道复位联合Jail螺钉技术固定治疗孤立性胫骨平台后外侧塌陷骨折临床疗效满意,可避免继发性的关节面塌陷发生。Objective To investigate the clinical efficacy of minimally invasive reduction through bone tunnel combined with Jail screw fixation technique for the treatment of isolated posterolateral tibial plateau collapse fractures.Methods A retrospective analysis was made on clinical data of 25 patients who were diagnosed as having isolated posterolateral tibial plateau collapse fractures from October 2016 to October 2020.The Mimics20.0 software was used for preoperative planning.All the patients were treated by cannulated rammer in tibial tunnel to reduce the collapsed fractures,and the tibial plateau posterolateral fractures were fixed with the Jail screws.The articular surface collapse distance,posterior slope angle(PSA)and the Rasmussen anatomical score of the tibial plateau were compared among before operation,on the second day after operation and one year after operation.The knee joint function was evaluated by the Hospital for Special Surgery(HSS)score on the second day after operation and one year after operation.Results The operation time was 35-60 min(mean,55.6±4.4 min).The amount of bleeding was 10-50 ml(mean,20.6±9.2 ml).Bone primary healing was achieved within 8-12 weeks(mean,10.5±1.3 weeks).All the 25 patients were followed up for 12-36 months(mean,16.5±4.1 months).The collapse distance of articular surface recovered from(9.2±2.2)mm before operation to(1.0±0.4)mm on the second day after surgery and to(1.1±0.1)mm at 1 year after operation(all P=0.000).The PSA recovered from 21.2°±2.1°before operation to 8.9°±0.9°on the second day after surgery and to 9.2°±0.6°at 1 year after operation(all P=0.000).The Rasmussen anatomical scores recovered from preoperative(7.8±1.8)points to(17.1±1.0)points on the second postoperative day and to(16.3±0.7)points 1 year after operation(all P=0.000).Compared with the second day after operation,there were no significant differences in the articular surface collapse distance,posterior inclination angle and the Rasmussen anatomical scores of the tibial platform at

关 键 词：胫骨平台骨折 后外侧骨折 Jail螺钉技术 骨折固定术 

分 类 号：R687.3[医药卫生—骨科学]