摘要
目的探讨过伸外翻型胫骨平台骨折的临床特点及治疗策略。方法回顾分析2016年1月至2020年12月四川省骨科医院收治的11例过伸外翻型胫骨平台骨折患者资料,男7例,女4例;年龄24~65岁,平均(50.4±5.7)岁。骨折采用切开复位植骨钢板螺钉内固定治疗,合并的股骨内髁撕脱骨折根据术中情况行保守治疗或进一步行内固定治疗。术后定期随访,记录骨折愈合时间、并发症发生情况;采用疼痛视觉模拟评分(visual analogue score,VAS)、膝关节屈伸活动度(range of motion,ROM)、美国特种外科医院(hospital for special surgery,HSS)膝关节评分评价临床疗效。结果11例患者术后均获得随访,随访时间12~18个月,平均(10.4±4.8)个月;骨折愈合时间12~15周,平均(11.8±4.5)周;术后均未出现切口感染、内固定失败及骨折不愈合等并发症;随术后时间推移,VAS评分逐渐降低,膝关节HSS评分及膝关节屈伸活动度逐渐增加,三者不同时间点比较差异均有统计学意义(P<0.01);末次随访时所有患者膝关节稳定性良好,下肢力线及步态无异常,膝关节无僵硬,可完全下蹲。结论过伸外翻型胫骨平台骨折是临床非常少见的损伤类型,常合并股骨内髁撕脱骨折,充分认识其冠状位对角线损伤机制并规范治疗可以取得满意疗效。
Objective To investigate the clinical characteristics and treatment of hyperextension valgus tibial plateau fracture.Methods Data of 11 patients with hyperextension and eversion tibial plateau fracture admitted to our hospital from January 2016 to December 2020 was retrospectively analyzed.7 males and 4 females were included.The patients aged from 24 to 65 years,with an average of(50.4±5.7)years.Fractures were treated with open reduction,bone graft,plate and screw internal fixation.Concomitant avulsion fractures of the femoral condyle were treated with conservative treatment or further internal fixation according to the intraoperative conditions.Regular follow-up was performed to record the time of fracture healing and the occurrence of complications.Visual analogue score(VAS),range of motion(ROM),hospital for special surgery(HSS)knee score to evaluate the clinical efficacy.Results All 11 patients were followed up for 12 to 18 months,with an average of(10.4±4.8)months.Fracture healing time ranged from 12 to 15 weeks,with an average of(11.8±4.5)weeks.There were no postoperative complications such as incision infection,internal fixation failure and fracture nonunion.VAS score gradually decreased,knee HSS score and knee flexion and extension activity gradually increased,with statistical significance at different time points(P<0.01).At the last follow-up,all patients had good stability of knee joint,no abnormality of lower limb force line and gait,no stiffness of knee joint,and could squat completely.Conclusion Tibial plateau fracture with hyperextension and eversion is a very rare type of injury in clinic.It is often associated with avulsion fracture of medial femoral condyle.A full understanding of the mechanism of coronal diagonal injury and standardized treatment can achieve satisfactory results.
作者
王晓刚
徐强
张清晏
苏龙辉
Wang Xiaogang;Xu Qiang;Zhang Qingyan;Su Longhui(Department of Lower Limbs,Sichuan Orthopaedic Hospital,Chengdu 610041,China)
出处
《实用骨科杂志》
2022年第7期607-610,共4页
Journal of Practical Orthopaedics
关键词
胫骨平台
过伸
股骨内髁
撕脱骨折
对角线
tibial plateau
hyperextension
medial femoral condyle
avulsion fracture
diagonal
