经外侧平台非核心负重区截骨复位内固定治疗伴后外侧柱塌陷的胫骨平台骨折  

Osteotomy of non-core weight-bearing area of the lateral tibial plateau,reduction,and internal fixation in treatment of tibial plateau fractures involving posterolateral column collapse

作　　者：裴璇 汪国栋 钱胜龙 程翼鹏 方志勋 柯烯 刘曦明 PEI Xuan;WANG Guodong;QIAN Shenglong;CHENG Yipeng;FANG Zhixun;KE Xi;LIU Ximing(Department of Orthopedics,General Hospital of Central Theater Command of Chinese PLA,Wuhan Hubei,430070,P.R.China;School of Medicine,Wuhan University of Science and Technology,Wuhan Hubei,430081,P.R.China;First School of Clinical Medicine,Southern Medical University,Guangzhou Guangdong,510515,P.R.China)

机构地区：[1]中国人民解放军中部战区总医院骨科,武汉430070 [2]武汉科技大学医学院,武汉430081 [3]南方医科大学第一临床医学院,广州510515

出　　处：《中国修复重建外科杂志》2023年第4期410-416,共7页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：解放军中部战区总医院育英计划资助(ZZYCZ202111);卫勤保障能力创新与生成专项(20WQ034);2021年度湖北省卫健委首届转化医学项目(WJ2021ZH0010)。

摘　　要：目的探讨经外侧平台非核心负重区截骨复位内固定治疗伴后外侧柱塌陷的胫骨平台骨折的疗效。方法回顾分析2015年1月—2021年6月采用经外侧平台非核心负重区截骨复位内固定治疗的23例伴后外侧柱塌陷的胫骨平台骨折患者临床资料。其中男14例,女9例;年龄26~62岁,平均42.6岁。致伤原因:交通事故伤16例,高处坠落伤5例,其他伤2例。骨折按Schatzker分型:Ⅴ型15例,Ⅵ型8例。受伤至手术时间为4~8 d,平均5.9 d。记录患者手术时间、术中出血量、骨折愈合时间及并发症;比较术前、术后2 d及6个月后外侧柱关节面塌陷深度、胫骨平台后倾角(posterior inclination angle,PSA),采用Rasmussen解剖评分评估胫骨平台骨折复位情况;术后2 d及6个月采用美国特种外科医院(HSS)评分评价膝关节功能恢复情况。结果23例患者均顺利完成手术。手术时间120~195 min,平均152.8 min;术中出血量50~175 mL,平均109.5 mL。所有患者均获随访,随访时间12~24个月,平均16.7个月。术后1例出现切口浅表感染,经换药后愈合;其余患者切口均Ⅰ期愈合。骨折均愈合,愈合时间12~18周,平均13.7周。末次随访时无内固定失效,无膝关节内、外翻畸形及膝关节不稳等并发症发生。1例患者出现关节僵硬,膝关节活动度10°~100°;其余患者膝关节活动度0°~125°。术后2 d及6个月的后外侧柱关节面塌陷深度、PSA及Rasmussen解剖评分均较术前显著改善(P<0.05);术后2个时间点间差异无统计学意义(P>0.05)。术后6个月HSS评分显著高于术后2 d(P<0.05)。结论对于伴后外侧柱塌陷的胫骨平台骨折,经外侧平台非核心负重区截骨复位内固定具有充分显露后外柱骨折块、关节面复位效果佳、术中充分植骨及术后并发症少等优点,有利于膝关节功能恢复。Objectivee To investigate the effectiveness of osteotomy of non-core weight-bearing area of the lateral tibial plateau,reduction,and internal fixation in the treatment of tibial plateau fractures involving posterolateral column collapse.Methods A clinical data of 23 patients with tibial plateau fractures involving posterolateral column collapse,who had undergone osteotomy of non-core weight-bearing area of the lateral tibial plateau,reduction,and internal fixation between January 2015 and June 2021,was retrospectively analyzed.There were 14 males and 9 females with an average age of 42.6 years ranging from 26 to 62 years.The causes of injury included traffic accident in 16 cases,falling from height in 5 cases,and other injuries in 2 cases.According to Schatzker classification,there were 15 cases of type V and 8 cases of type VI.The time from injury to operation was 4-8 days with an average of 5.9 days.The operation time,intraoperative blood loss,fracture healing time,and complications were recorded.The depth of articular surface collapse of posterolateral column and posterior inclination angle(PSA)of the tibial plateau were compared before operation and at 2 days and 6 months after operation;fracture reduction of tibial plateau fracture was evaluated by Rasmussen anatomic score.The recovery of knee function was evaluated by Hospital for Special Surgery(HSS)score at 2 days and 6 months after operation.ResultsAll 23 patients were completed the operation successfully.The operation time was 120-195 minutes,with an average of 152.8 minutes;the intraoperative blood loss was 50-175 mL,with an average of 109.5 mL.All patients were followed up 12-24 months,with an average of 16.7 months.One patient had superficial wound infection after operation,and the incision healed after dressing change;primary healing of incision of other patients was obtained.The fracture healing time was 12-18 weeks,with an average of 13.7 weeks.No failure of internal fixation,varus and valgus deformity of the knee joint,and instability of the knee

关 键 词：胫骨平台骨折 截骨 复位 内固定 

分 类 号：R687.3[医药卫生—骨科学]