腓骨头上入路环形钢板治疗后外侧胫骨平台骨折  

Treatment of posterolateral tibial plateau fracture with annular plate through the supra-fibular-head approach

作　　者：高峰[1] 徐锋[1] 匡辰 杨荃 熊晓扬 吴晓峰[1] Gao Feng;Xu Feng;Kuang Chen;Yang Quan;Xiong Xiaoyang;Wu Xiaofeng(Department of Orthopedics,Kunshan Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Traditional Chinese Medicine,Kunshan Jiangsu,215300,China)

机构地区：[1]南京中医药大学附属昆山市中医医院关节骨科,江苏昆山215300

出　　处：《生物骨科材料与临床研究》2022年第6期53-56,64,共5页Orthopaedic Biomechanics Materials and Clinical Study

基　　金：昆山市科技计划项目(KS1965)。

摘　　要：目的探讨腓骨头上入路结合环形钢板在胫骨平台后外侧柱骨折中的运用及临床疗效。方法回顾分析2019年1月至2021年6月期间南京中医药大学附属昆山市中医医院收治的19例累及后外侧柱的外侧胫骨平台骨折临床资料。其中,男11例,女8例;年龄32~65岁,平均46.3岁。根据四柱理论分型:单纯后外侧柱骨折6例,后外侧合并前外侧柱骨折13例。采用腓骨头上入路,骨折复位,塌陷区填充人工骨,3.5 mm后踝“T”型锁定钢板剪去一侧臂后折弯成环形并贴附包绕外侧平台边缘,以排筏螺钉固定。术后定期随访,根据Rasmussen放射评分评价复位质量,HSS评分评价膝关节功能。结果所有患者术后均获得随访10~24个月,平均14.8个月。手术时间平均为(83.7±14.1)min,骨折愈合时间平均为(15.7±3.4)周,完全负重时间平均为(19.3±2.5)周。末次随访时膝关节活动度平均为(118.6±15.2)°;Rasmussen放射评分:优10例,良8例,可1例,优良率94.7%;膝关节功能HSS评分:优12例,良5例,可2例,优良率89.5%。结论腓骨头上入路治疗后外侧胫骨平台骨折操作简便安全,联合环形钢板内固定可靠,近期临床疗效满意。Objective To investigate the application and clinical effect of superior peroneal approach combined with annular plate in the treatment of posterolateral condylar fracture of tibial plateau.Methods The clinical data of 19 cases of lateral tibial plateau fractures involving the posterolateral condyle treated in Kunshan Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Traditional Chinese Medicine from January 2019 to June 2021 were retrospectively analyzed.There were 11 males and 8 females,aged from 32 to 65 years,with an average of 46.3 years.According to the four-column theory,there were 6 cases of simple posterolateral column fracture and 13 cases of posterolateral combined anterolateral column fracture.The supra-fibular-head approach was used to reduce the fracture,fill the collapsed area with artificial bone,cut off one arm with 3.5mm posterior malleolus T-shaped locking plate,bend it into ring shape to wrap around the edge of the lateral platform,and fix it with raft screws.The patients were followed up regularly after operation.The reduction quality was evaluated according to Rasmussen radiation score,and the knee function was evaluated according to HSS score.Results All patients were followed up for 10-24 months,with an average of 14.8 months.The operation time was(83.7±14.1)min,the fracture healing time was(15.7±3.4)weeks,and the complete weight-bearing time was(19.3±2.5)weeks.At the last follow-up,the average range of motion of the knee was(118.6±15.2)°.Rasmussen radiation score:Excellent in 10 cases,good in 8 cases and fair in 1 case,with an excellent and good rate of 94.7%.HSS score of knee function:excellent in 12 cases,good in 5 cases and fair in 2 cases.The excellent and good rate was 89.5%.Conclusion The treatment of posterolateral tibial plateau fractures by superior peroneal approach is simple and safe,combined with reliable internal fixation with annular plate.The short-term clinical effect is satisfactory.

关 键 词：后外侧胫骨平台骨折 腓骨头上 环形钢板 内固定 

分 类 号：R687.3[医药卫生—骨科学]