摘要
目的 探讨过伸型胫骨平台骨折的治疗策略,并分析采用悬垂体位、撬拨法的优势。 方法 回顾性分析2006年8月至2017年6月治疗过伸型胫骨平台骨折15例患者资料,男14例,女1例;年龄32-55岁,平均42.2岁。术前牵引、充分消肿,行三维CT扫描明确骨折塌陷程度及部位,并行MR检查明确韧带损伤情况。手术采用悬垂体位、内外侧联合入路、撬拨法复位塌陷的关节面,术中或辅助关节镜监视胫骨平台关节面的复位情况,髂骨结构性植骨联合同种异体骨植骨。侧副韧带及半月板一期修复,交叉韧带二期重建。 结果 15例受伤至手术时间7-14 d,平均(9.8±0.61)d。15例均顺利完成手术,手术时间为90-160 min,平均121 min,术中出血为(86±35)ml。15例均获得随访,所有患者均达到骨折愈合,骨折愈合时间为12-16周,平均13.5周;随访期间无内固定物松动或断裂以及再骨折的发生。术后复查X线片均达到解剖复位标准,随访期间未见关节面复位丢失,术后即刻、3个月、6个月、12个月复查胫骨平台后倾角和内翻角对比的差异无统计学意义。术后末次随访的膝关节功能评估,关节稳定性均正常,膝关节屈伸活动范围0-140°;术后12个月采用美国特种外科医院膝关节评分(hospital for special surgery knee score,HSS)80-97分,平均(89.47±1.27)分;Lysholm评分为93-100分,平均(95.40±0.67)分;Rasmussen临床评分22-28分,平均(24.93±0.54)分,优5例,良10例;Rasmussen放射评分为14-18分,平均(15.47±0.36)分,优2例,良13例。 结论 过伸型胫骨平台骨折是一种下肢伸膝位损伤,后倾角度丢失甚至变成前倾,采用悬垂体位和撬拨复位的方法便于术区显露,以助于恢复关节面的后倾及平整,适用于临床。
Objective To discuss the clinical characteristic and therapeutic strategy of the hyperextension tibial plateau fracture, and analyze thesuperiority of suspend position and leverage reduction. Methods Fifteen patients with an average age of 42.2 years old(range, 32-55 years;14 males,1 females)surgically treated from August 2006 to June 2017 were included. Traction and sufficient detumescence pre-operation, three-dimensional CT examination were used to clarify the site and the collapse degree of the fracture. Magnetic Resonance Imaging were used to verifythe injury of ligament. All the patients were adopt suspend position, anterolateral and medial incision and the leverage reduction method.The articular surface of tibial plateau were observed with arthroscope. Iliac bone were used for structural bone graft and allograft bone were used for non-structural bone graft. The collateral ligaments and meniscusshould be repaired in the meantime, while the cruciate ligaments would be reconstructed at second phase. Results Fifteenpatients underwent preoperative preparation for 7-14 d, with an average of 9.8 ±0.61 d. The operation was successfully completed. The operation time was between 90-160 minutes, with an average of 121 minutes. The intraoperative bleeding was 86±35ml. All cases were followed-up. All patients gained bone union during 12-16 weeks after operation, with an average of 13.5 weeks. No loosening or breakage of internal fixation and no refracture occured during follow-up.All achieved the anatomical reduction post operation with X-ray scan. No reduction of articular surface lostduring follow-up. There was no statistical difference-in contrast posterior slope angle and varus angle of tibialplateau at postoperation, 3 month, 6 monthand 12 month follow-up. At final follow-up, the knee joint function was evaluated. The joint was stable and the range of flexion and extension of knee joint were 0-140°. At 12 month after operation, the HSS (The Hospital for Special Surgery)score were 80-97, with an average of 89.47�
作者
王耀宗
张英
Wang Yaozong;Zhang Ying(Department of Orthopaedics,the ZhongShan Hospital,affiliated of Xiamen University,Xiamen 361000,China)
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2019年第2期83-89,共7页
Chinese Journal of Orthopaedics
关键词
胫骨骨折
体位
骨折固定术
内
Tibial fractures
Posture
Fracture fixation, internal
