经改良腓骨头上入路Gerdy结节截骨治疗累及后外侧髁的SchatzkerⅣ型胫骨平台骨折  

Schatzker typeⅣtibial plateau fracture involving the posterior lateral condyle treated by a modified peroneal head approach with Gerdy node osteotomy

作　　者：霍永峰 殷照阳 孙宏[3] 于健 徐刚 顾光学 孟祥圣 孙晓 邹俊[1] HUO Yongfeng;YIN Zhaoyang;SUN Hong;YU Jian;XU Gang;GU Guangxue;MENG Xiangsheng;SUN Xiao;ZOU Jun(Department of Orthopaedics,the First Affiliated Hospital of Soochow University,Soochow 215008,Jiangsu;Department of Orthopaedics,Affiliated Hospital of Kangda College,Nanjing Medical University,Lianyungang Hospital affiliated of Xuzhou Medical University,Lianyungang 222002,Jiangsu;Jiangsu Provincial Center for Disease Control and Prevention,Nanjing 210009,Jiangsu,China)

机构地区：[1]苏州大学附属第一医院骨科,江苏苏州215008 [2]南京医科大学康达学院附属医院徐州医科大学附属连云港医院骨科,江苏连云港222002 [3]江苏省疾病预防控制中心,南京210009

出　　处：《中华骨与关节外科杂志》2023年第10期927-934,共8页Chinese Journal of Bone and Joint Surgery

基　　金：连云港市卫生科技项目基金(202107)。

摘　　要：目的:探讨经改良腓骨头上入路Gerdy结节截骨治疗累及后外侧髁的SchatzkerⅣ型胫骨平台骨折的临床疗效。方法:回顾性分析2016年1月至2021年3月收治的52例累及后外侧髁的SchatzkerⅣ型胫骨平台骨折患者的临床资料。27例接受改良腓骨头上入路前外侧Gerdy结节截骨治疗,应用内侧支撑接骨板及外侧排筏接骨板固定骨折,作为改良腓骨头上入路组;25例接受后内侧倒L入路联合前外侧入路手术治疗骨折,应用内侧支撑接骨板及后外侧支持接骨板固定骨折,作为后内侧倒L入路组。比较两组患者的手术时长、术中出血量、住院天数及1年随访时膝关节功能恢复情况。结果:52例患者术后随访12~24个月,平均(14.1±1.9)个月。改良腓骨头上入路组手术时间、出血量及住院天数均显著少于后内侧倒L入路组(P<0.05)。改良腓骨头上入路组术后即刻骨折复位质量Rasmussen评分、术后1年HSS评分高于后内侧倒L入路组,差异均有统计学意义(P<0.05)。后内侧倒L入路组的并发症发生率显著高于改良腓骨头上入路组(16.0%vs.3.7%,χ^(2)=4.316,P=0.038)。未出现无内固定松动,X线片示骨折均获愈合,未见血管、神经损伤等手术相关并发症发生。结论:对于累及后外侧髁的SchaztkeⅣ型胫骨平台骨折,经改良腓骨头上入路Gerdy结节截骨允许足够的空间对骨折进行直接显露及操作,内侧支撑接骨板联合外侧排筏锁定接骨板骨折固定骨折可靠,手术体位摆放及术中透视方便,并发症少,术后功能恢复良好,疗效满意。Objective:To investigate the clinical efficacy of Gerdy tubercle osteotomy through a modified supra-fibular-head approach in the treatment of Schatzker typeⅣtibial plateau fractures involving posterolateral condyle.Methods:The clinical data of 52 patients with Schatzker typeⅣtibial plateau fracture involving the posterolateral condyle from January 2016 to March 2021 were retrospectively analyzed.Twenty-seven patients received an anterolateral Gerdy tubercle osteotomy through the modified supra-fibular-head approach,and the fractures were fixed with an internal support bone plate and a lateral buttress bone plate,constituting the modified fibular-head approach group.Twenty-five patients underwent a posteromedial inverted"L"approach combined with an anterolateral approach to treat the fracture,with medial and posterolateral support bone plates for fracture fixation,constituting the posteromedial reversed"L"approach group.The operation duration,intraoperative blood loss,length of hospital stay,and the functional recovery of knee joint at 1-year follow-up were compared between the two groups.Results:A total of 52 patients were followed up for 12 to 24 months(mean:14.1±1.9 months).Patients in the modified fibular-head approach group exhibited significantly shorter operation duration,less intraoperative blood loss and a shorter length of hospital stay than those in the posteromedial reversed"L"approach group(P<0.05).The Rasmussen score and the 1-year postoperative Hospital for Special Surgery(HSS)score were significantly higher in the modified fibular-head approach group compared to the posteromedial reversed"L"approach group(all P<0.05).The complication rate was significantly higher in the posteromedial reversed"L"approach group compared to the modified fibular-head approach group(16.0%vs.3.7%,χ^(2)=4.316,P=0.038).No cases of internal fixation loosening or surgical complications s uch as vascular or nerve injuries were observed.X-ray images showed that all fractures were healed.Conclusions:For Schaztke typeⅣti

关 键 词：胫骨骨折 骨折固定 内 后外侧 接骨板 截骨 

分 类 号：R683.4[医药卫生—骨科学]