克氏针撬拨复位治疗复杂过伸型胫骨平台骨折体会  

Experience in the Treatment of Complex Hyperextension Tibial Plateau Fracture with Kirschner Needle Prying Reduction

作　　者：张海峰 汤继磊 Zhang Haifeng;Tang Jilei(Orthopedics,Qidong Hospital of Traditional Chinese Medicine,Qidong,Jiangsu,226200,China)

机构地区：[1]启东市中医院骨科,江苏启东226200

出　　处：《黑龙江医学》2024年第14期1700-1703,共4页Heilongjiang Medical Journal

摘　　要：目的:探讨克氏针撬拨复位治疗伴后皮质损伤的复杂过伸型胫骨平台骨折的临床疗效。方法:选取2016年1月—2021年6月启东市中医院骨科收治的13例复杂过伸型胫骨平台骨折患者作为研究对象。患者骨折均累及双髁伴后方皮质断裂,均采用内外侧联合入路,克氏针撬拨复位,双钢板或三钢板固定,修复合并的软组织损伤,术后在限制性支具保护下进行功能锻炼,定期复查X线评估骨折愈合情况及复位情况,末次随访时采用Rasmussen放射学评分评估胫骨平台骨折复位情况,采用美国特种外科医院(HSS)评分评估膝关节功能。结果:13例患者均顺利完成手术,手术时间120~200 min,平均手术时间148 min;术中出血量250~400 mL,平均术中出血量300 m L。13例患者均获得完整随访,随访时间12~18个月,平均随访时间15.6个月。13例患者均获得骨性愈合,临床愈合时间8~18周,平均愈合时间14.3周。末次随访时无膝关节疼痛及膝关节不稳,膝关节活动度0°~135°。术后12个月,Rasmussen胫骨平台骨折放射学评分为14~18分,平均评分(15.32±0.51)分。术后12个月,HSS膝关节功能评分为83~97分,平均(92.38±1.32)分。结论:复杂过伸型胫骨平台骨折后倾角明显改变甚至前倾,克氏针撬拨复位技术应用简单,有利于平台后倾角的恢复。Objective:To investigate the clinical effect of K-wire prying reduction in the treatment of complex hyperextension tibial plateau fractures with posterior cortical injury.Methods:From January 2016 to June 2021,13 patients with complex hyperextension tibial plateau fractures operationed in the Department of Orthopedics,Qidong Hospital of Traditional Chinese Medicine were selected as study subjects.The double condyle and the posterior cortex was broken in all the patients,and all patients were fixed by medial and lateral incision,K-wire prying reduction,double or triple plates,and repaired the combined soft tissue injury.The fracture healing and reduction were evaluated by X-ray.At the last follow-up,the Rasmussen radiological score was used to evaluate the tibial plateau fracture reduction,and the hospital for special surgery(HSS)score was used to evaluate the knee joint function.Results:All 13 cases were operationed successfully,and the operation time was 120~200 minutes,with an average of 148 minutes.The intraoperative blood loss was 250~400 mL,and the average intraoperative blood loss was 300 mL.All 13 cases were followed up for 12~18 months,with an average of 15.6 months.All patients achieved bony union,and the clinical healing time was 8~18 weeks,with an average of 14.3 weeks.The score of Rasmussen radiation 12 months after operation was 14~18.The average score was(15.32±0.51).There was no joint pain and unstable knee joint at the last follow-up,and the knee joint activity reached 0°~135°12 months after surgery,HSS knee function scores ranged from 83 to 97,with an average of(92.38±1.32)points.Conclusion:The retroversion angle of complex hyperextension tibial plateau fractures changes significantly or even anteverts.The K-wire prying reduction technique is simple to apply,which is beneficial to the recovery of the posterior tilt angle of the tibial plateau.

关 键 词：克氏针 撬拨复位 过伸型 胫骨平台骨折 

分 类 号：R687.3[医药卫生—骨科学]