经外侧平台前缘骨折线与胫前开窗治疗胫骨平台前外侧柱骨折合并后外侧柱塌陷的疗效比较  

Comparison of efficacy of anterolateral tibial plateau fracture line and anterior tibial fenestration for the treatment of anterolateral tibial plateau column fracture combined with posterolateral column collapse

作　　者：孟乘飞 王冠清 罗程 刘修华 凌泽喜 MENG Cheng-fei;WANG Guan-qing;LUO Cheng;LIU Xiu-hua;LING Ze-xi(Department of Orthopaedics,Wuhan Orthopaedics Hospital of Integrated Chinese&Western Medicine the Affiliated Hospital of Wuhan Sports University,Wuhan430079,Hubei,China)

机构地区：[1]武汉中西医结合骨科医院,武汉体育学院附属医院骨科,湖北武汉430079

出　　处：《中国骨伤》2025年第3期265-272,共8页China Journal of Orthopaedics and Traumatology

摘　　要：目的:比较经外侧平台前缘骨折线与胫前开窗复位治疗胫骨平台前外侧柱骨折合并后外侧柱塌陷的临床疗效。方法:回顾性分析2016年1月至2021年12月收治的52例SchatzkerⅡ型胫骨平台前外侧柱骨折合并后外侧柱塌陷患者,根据骨折复位方式分为两组。经骨折线组27例,男19例,女8例;年龄26~62(43.2±11.4)岁;受伤至手术时间4~8(5.8±1.5)d;采用经外侧平台前缘骨折线复位内固定治疗。开窗组25例,男13例,女12例;年龄22~69(40.8±11.1)岁;受伤至手术时间4~8(6.0±1.4)d;采用胫骨开窗复位内固定治疗。比较两组植骨量、手术时间、骨折愈合时间及并发症情况。比较术前、术后2 d及6个月外侧平台关节面塌陷深度、外侧胫骨平台后倾角(posterior slope angle,PSA)。分别于术后2 d及6个月采用美国特种外科医院(Hospital for Speical Surgery,HSS)膝关节评分进行膝关节功能评价。采用膝关节Rasmussen解剖评分评定骨折复位情况。结果:两组均获得随访,时间12~24(16.0±3.4)个月。两组患者随访期间未发现骨折再移位、膝关节内外翻畸形、膝关节不稳。经骨折线组1例伤口出现脂肪液化,2例出现下肢肌间静脉血栓;开窗组1例出现关节僵硬,1例出现下肢肌间静脉血栓,1例伤口浅表感染;两组并发症比较,差异无统计学意义(P>0.05)。经骨折线组植骨量、手术时间、骨折愈合时间分别为(3.6±2.3)cm3、(123.4±18.2)min、(13.8±1.8)周,开窗组分别为(4.8±1.8)cm3、(135.5±22.5)min、(15.2±2.0)周,两组比较差异有统计学意义(P<0.05)。术后2 d及6个月经骨折线组外侧平台关节面塌陷深度分别为(0.8±0.1)、(0.9±0.1)mm,小于开窗组(0.9±0.1)、(1.1±0.1)mm,差异有统计学意义(P<0.05);经骨折线组PSA分别为(9.4±1.5)°、(10.1±1.9)°,小于开窗组的(10.5±1.5)°、(11.3±1.9)°,差异有统计学意义(P<0.05);经骨折线组Rasmussen解剖评分分别为16(16,18)、16(14,16)分,优于开窗组16(16,16)�Objective To compare clinical effect of anterior tibial plateau fracture line and anterior tibial fenestration reduction in treating anterolateral tibial plateau column fracture combined with posterior lateral column collapse.Methods Fifty-two patients with Schatzker typeⅡtibial plateau anterolateral column fracture combined with posterolateral column collapse admitted from January 2016 to December 2021 were retrospectively analyzed and divided into two groups according to fracture reduction methods.There were 27 patients in fracture line group,including 19 males and 8 females,aged from 26 to 62 years old with an average of(43.2±11.4)years old;the time from injury to operation ranged from 4 to 8 days with an average of(5.8±1.5)days;treated with reduction and internal fixation via fracture line of lateral platform front.There were 25 patients in fenestrate group,including 13 males and 12 females,aged from 22 to 69 years old with an average of(40.8±11.1)years old;the time from injury to operation ranged from 4 to 8 days with an average of(6.0±1.4)days;treated with tibial fenestration reduction and internal fixation.The amount of bone graft,operation time,fracture healing time and complications were compared between two groups.Posterior slope angle(PSA)and posterior slope angle of the lateral tibial plateau was compared before surgery,2 days and 6 months after surgery.The knee function was evaluated by Hospital for Speical Surgery(HSS)at 2 days and 6 months after surgery,respectively.Fracture reduction was evaluated by Rasmussen anatomic score of knee joint.Results Both of group were followed up from 12 to 24 months(16.0±3.4)months.No redisplacement of fracture,internal and external inversion deformity of knee joint,or instability of knee joint were found between two groups during follow-up.In fracture line group,1 patient occurred wound fat liquefaction and 2 patients occurred lower limb intermuscular venous thrombosis occurred.In fenestration group,1 patient occurred joint stiffness,1 patient occurred lower

关 键 词：胫骨骨折 膝关节 骨折固定术 内 病例对照研究 

分 类 号：R683.42[医药卫生—骨科学]