摘要
目的探讨经膝外侧腓骨截骨入路治疗胫骨平台后外侧骨折的手术方法和临床疗效。方法2011年1月至2013年1月,收治胫骨平台后外侧骨折患者18例,男13例,女5例。年龄23.0～62.0岁,平均40.6岁。按AO分型:B3型8例,C3型10例。CT扫描和三维重建示后外侧平台劈裂塌陷,8例合并腓骨头或上端骨折。B3型骨折采用膝外侧腓骨截骨入路,C3型骨折采用联合入路(外侧+后内侧入路),直视下撬拨后外侧塌陷骨块并行植骨及支撑钢板内固定。对于骨折复位情况采用DeCoster评定标准,对于膝关节功能采用HSS膝关节评分标准。结果术后X线片按DeCoster评定标准评定,达到解剖复位12例,良好4例,一般2例;18例患者均获得6.0～24.0个月随访,平均12.2个月。术后3.0个月,复查X线片显示骨折均已愈合,高度未见丢失,HSS评分为84.0～95.0分,平均88.9分。2例腓总神经麻痹,2个月后自行恢复,1例术后伤口感染经清创后愈合。结论外侧腓骨近端截骨入路能充分暴露后外侧平台,直视下对后外侧劈裂骨折进行复位和内固定,值得临床推广应用。
Objective To explore surgical techniques and clinical outcomes through the lateral fibular osteotomy approach in the treatment of posterolateral shearing tibial plateau fractures.Methods Between Jan.2011 and Jan.2013,18 patients with posterolateral shearing tibial plateau fractures had been treated by this approach.The patient population comprised of 13 males and 5 females whose mean age at surgery was 40.6 years old（range23-62）.According to the AO classification,there were 8 fractures of B3 and 10 of C3.The fracture pattern was lateral plateau split-depression type in all of the patients undergoing a common CT scan and three-dimensional（3D）CT reconstruction of proximal tibia on admission,and 8 patients were associated with the head or upper end of the fibular fracture.The B-type fractures were reduced through the straight laternal approach,and the C-type fractures were treated with combined posteromedial approach.Fracture reduction,bone graft and buttress plate fixation have been achieved manually under the direct vision.The quality of reduction was assessed according to the methods of DeCoster,and the function of the knee joint was evaluated with the Hospital for Special Surgery（HSS）knee Score.Results The anatomical reduction was achieved in most of the patients,and 12 reductions were graded as excellent,4 as good and 2 as fair.The average duration of follow-up was 12.2（rang of 6 to 24）months and all fractures healed when re-examined 12 weeks after operation.None of the patients developed secondary loss of reduction.The average HSS knee score was 88.9（range of 84 to 95）.Palsy of the peroneal nerve was found in 2 patients after operation but recovered 2 months later.Wound infection was found in1 patient and healed after debridment.Conclusion With allowing excellent visualization,accurate reduction and optimal plate placement,the lateral fibular osteotomy approach mentioned in this article was an appropriate and adequate solution for posterolateral shearing tibial plateau fractures.
出处
《骨科》
CAS
2014年第3期151-153,157,共4页
ORTHOPAEDICS
关键词
胫骨骨折
腓骨
截骨术
骨折固定术
内
Tibial fractures
Fibula
Osteotomy
Fracture fixation
internal
