膝关节后内侧入路联合胫后骨隧道撬拨复位技术治疗胫骨平台后外侧柱骨折  

Posteromedial approaches combined with posterior tibial bone tunnel lever reduction technique for the treatment of posterolateral tibial plateau fractures

作　　者：胡力轩 殷钦 蒋涛[1] 白瑞军 邵牧 吴永伟[1] 顾三军[1] 芮永军[1] 刘宇[1] HU Lixuan;YIN Qin;JIANG Tao;BAI Ruijun;SHAO Mu;WU Yongwei;GU Sanjun;RUI Yongjun;LIU Yu(Department of Orthopaedics,Wuxi Ninth Hospital Affiliated to Soochow University,Wuxi 214062,Jiangsu,China)

机构地区：[1]苏州大学附属无锡九院骨科,江苏无锡214062

出　　处：《中华骨与关节外科杂志》2025年第4期324-330,共7页Chinese Journal of Bone and Joint Surgery

基　　金：无锡市“双百”中青年医疗卫生拔尖人才培养计划(HB2023125)。

摘　　要：目的:探讨膝关节后内侧入路联合胫后骨隧道撬拨复位技术治疗胫骨平台后外侧柱骨折的手术方法及临床疗效。方法:回顾性分析2018年1月至2020年6月无锡市第九人民医院应用膝关节后内侧入路联合胫后骨隧道撬拨复位技术治疗的16例胫骨平台后柱骨折患者的临床资料,男10例,女6例;年龄21~70岁,平均(44.1±15.8)岁;左侧7例,右侧9例;单纯后外侧柱骨折9例,后内侧柱合并后外侧柱骨折7例。手术均采用膝关节后内侧入路联合胫后骨隧道撬拨复位技术复位后外侧骨折块。术中记录手术时间及失血量,末次随访通过疼痛视觉模拟评分(VAS),Lysholm膝关节评分及Rasmussen膝关节功能评分进行临床疗效评估。结果:16例患者手术时间为70~180 min,平均手术时间(97.8±28.8)min;术中失血量为40~110 mL,平均术中失血量(65.6±21.9)mL。16例患者获得10~32个月随访,中位数(四分位数)为12.5(10.3,14.8)个月,骨折均在4个月内达到临床愈合。除1例患者出现切口脂肪液化延迟愈合,其余15例均未出现感染、血管神经损伤、内固定失效等并发症。末次随访时,疼痛VAS评分0~3分,中位数(四分位数)为1(0,2)分;Lysholm膝关节评分90~96分,平均(93.3±2.1)分;Rasmussen膝关节功能评分19~29分,平均(27.0±2.6)分,优11例、良4例、中1例、差0例,优良率93.8%。1例患者要求二次手术取出内固定,其余患者均未取出内固定。结论:膝关节后内侧入路治疗胫骨平台后外侧柱骨折能够较好地暴露胫骨平台后柱(包括后内侧柱及后外侧柱),结合胫后骨隧道撬拨复位技术,能够提供满意的后柱骨折复位及牢靠固定,术后膝关节功能恢复快,疗效满意。Objective:To explore the surgical technique and clinical outcomes of posteromedial approach combined with posterior tibial bone tunnel lever reduction technique for the treatment of posterolateral tibial plateau fractures.Methods:A retrospective analysis was conducted on the clinical data of 16 patients with posterolateral tibial plateau fractures who were treated by posteromedial approach combined with posterior tibial bone tunnel lever reduction technique at Wuxi Ninth Hospital Affiliated to Soochow University from January 2018 to June 2020.The cohort included 10 males and 6 females;age range from 21 to 70 years old,with an average of(44.1±15.8)years old.Among them,7 cases involved the left side,and 9 cases the right side.There were 9 cases of isolated posterolateral column fractures and 7 cases of combined posteromedial and posterolateral column fractures.All patients underwent reduction of the posterolateral fracture fragment using the posteromedial approach combined with the posterior tibial bone tunnel lever reduction technique.The operative time and blood loss were recorded during the procedure.Clinical outcomes were evaluated at the final follow up using the Visual Analog Scale(VAS),Lysholm score,and Rasmussen functional score.Results:The average operative time for the 16 patients was(97.8±28.8)mins(range:70-180 min),and the average intraoperative blood loss was(65.6±21.9)mL(range:40-110 mL).Patients were followed up for 10-32 months,with a median(interquartile)of 12.5(10.3,14.8)months,,and all fractures achieved clinical healing within 4 months.One case developed delayed wound healing due to fat liquefaction,no complications such as infection,neurovascular injury,or internal fixation failure were observed in the remaining 15 patients.At the last follow-up,the pain VAS score ranges from 0 to 3 points,with a median(quartiles)of 1(0,2)point,the Lysholm score was(93.3±2.1)points(90-96 points)and the Rasmussen functional score was(27.0±2.6)points(19-29 points).Based on the Rasmussen score,11 cases were e

关 键 词：胫骨平台骨折 后外侧柱骨折 后内侧入路 

分 类 号：R683.4[医药卫生—骨科学]