过伸型胫骨平台双髁骨折内外侧双钢板内固定手术技巧与疗效分析  

Clinical effect and surgical technique of treatment of hyperextension bicondylar fractures of tibial plateau with bilateral plates

作　　者：白晓冬[1] 陈文韬[1] 许国强 王刚[1] 马骥 刘振宇[1] 李亚东[1] 赵亮[1] 高化[1] 王宝军[1] BAI Xiao-dong;CHEN Wen-tao;XU Guo-qiang;WANG Gang;MA Ji;LIU Zhen-yu;LI Ya-dong;ZHAO Liang;GAO Hua;WANG Bao-jun(Department of Orthopedics,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院创伤骨科,北京100050

出　　处：《中国骨与关节损伤杂志》2022年第12期1257-1261,共5页Chinese Journal of Bone and Joint Injury

摘　　要：目的观察采用内外侧入路双钢板内固定治疗过伸型胫骨平台双髁骨折的疗效,同时总结手术操作技巧。方法回顾性分析自2015-12—2020-12诊治的25例过伸型胫骨平台双髁骨折,选择内侧入路与前外侧入路显露骨折端,骨折复位后根据断端是否有骨缺损决定是否植骨,C型臂X线机透视确认骨折复位满意后放置内外侧钢板固定。末次随访时采用膝关节功能Lysholm评分与膝关节KOOS评分评定疗效。结果25例均获得随访,随访时间平均12.9(7~24)个月。术后均无骨筋膜室综合征、神经血管损伤、下肢深静脉血栓形成等并发症出现。1例前外侧切口愈合过程中出现皮下脂肪液化,换药后二期缝合,术后4周切口完全愈合。随访期间未出现感染、内固定失败、骨折延迟愈合、骨折不愈合等并发症,术后3个月随访时所有患者均达到骨折愈合标准。末次随访时膝关节功能Lysholm评分为79~95分,平均91.5分;膝关节KOOS评分为83~96分,平均90.9分。结论采用前外侧联合内侧入路切开复位内固定治疗过伸型胫骨平台双髁骨折可取得满意的临床疗效,骨折复位固定可靠,有利于促进骨折愈合,患者膝关节功能恢复满意,而注重手术操作细节是取得满意疗效的有效保障。Objective To observe the clinical effect of internal fixation with bilateral plates through medial approach and anterior lateral approach in the treatment of hyperextension bicondylar fractures of tibial plateau,and summarize the surgical techniques.Methods Retrospective analysis was made on 25 cases of hyperextension bicondylar fractures of tibial plateau diagnosed and treated from December 2015 to December 2020.To expose the fracture,the medial approach and anterolateral approach were used.After fracture reduction,bone grafting was determined according to whether there was a bone defect.The bilateral plates were placed after the C-arm X-ray fluoroscopy confirmed that the fracture reduction was satisfactory.At the last follow-up,Lysholm score and KOOS score were used to evaluate the knee joint function.Results All 25 cases were followed up for an average of 12.9(7-24)months.There were no complications such as osteofascial compartment syndrome,neurovascular injury,and deep vein thrombosis of lower limbs.One case had subcutaneous fatty liquefaction during the healing process of the anterolateral incision.The incision was completely healed 4 weeks after dressing.During the follow-up period,there were no complications such as infection,internal fixation failure,delayed fracture healing,and nonunion.All patients reached the fracture healing standard 3 months after surgery.At the last follow-up,the Lysholm score of knee joint function was 79-95,with an average of 91.5 points;KOOS score of knee joint was 83-96,with an average of 90.9.Conclusion The treatment of hyperextension bicondylar fractures of tibial plateau through anterolateral and medial approach for open reduction and internal fixation can achieve satisfactory clinical results.The reliable reduction and fixation of fractures are conducive to promoting fracture healing,and the patients’knee joint function recovery is satisfactory,while paying attention to the details of surgical procedure is an effective guarantee for achieving satisfactory results.

关 键 词：胫骨平台双髁骨折 过伸型损伤 双钢板 内固定 

分 类 号：R687.3[医药卫生—骨科学]