摘要
目的探讨胫骨近端外侧锁定接骨板排筏螺钉联合Jail螺钉治疗胫骨平台外侧塌陷骨折的疗效。方法采用回顾性病例系列研究分析2016年1月至2020年1月南京鼓楼医院集团宿迁医院收治的36例胫骨平台外侧塌陷骨折患者的临床资料,其中男19例,女17例;年龄34~68岁[(48.6±5.8)岁]。Schatzker分型:Ⅱ型28例,Ⅲ型8例。患者均采用胫骨近端外侧锁定接骨板排筏螺钉联合Jail螺钉固定治疗。记录手术时间、术中出血量、骨折愈合情况。比较术前、术后2 d及1年胫骨平台关节面塌陷距离、胫骨平台后倾角(PSA)、胫骨平台内翻角(TPVA)及Rasmussen解剖评分。术后2 d及1年采用美国特种外科医院(HSS)评分评价膝关节功能。观察并发症情况。结果患者均获随访12~32个月[(19.5±3.1)个月]。手术时间为56~82 min[(68.5±9.1)min]。术中出血量为40~100 ml[(75.6±10.2)ml]。骨折均Ⅰ期临床愈合,愈合时间为8~15周[(12.5±1.3)周]。胫骨平台关节面塌陷距离由术前(15.5±4.2)mm恢复至术后2 d及1年的(0.7±0.3)mm、(1.0±0.2)mm(P均<0.01);PSA由术前(21.2±2.1)°恢复至术后2 d及1年的(8.9±0.8)°、(9.2±0.6)°(P均<0.01);TPVA由术前(100.2±3.7)°恢复至术后2 d及1年的(88.9±1.8)°、(87.2±1.6)°(P均<0.05);Rasmussen解剖评分由术前(7.8±1.8)分恢复至术后2 d及1年的(17.1±0.9)分、(16.3±0.7)分(P均<0.01)。与术后2 d比较,术后1年胫骨平台关节面塌陷距离、PSA、TPVA及Rasmussen解剖评分差异无统计学意义(P均>0.05)。术后1年HSS评分为(92.8±3.2)分,明显高于术后2 d的(74.8±3.5)分(P<0.01)。术后2例出现伤口浅表感染,经清创换药后愈合,无深部感染发生。结论胫骨近端外侧锁定接骨板排筏螺钉联合Jail螺钉治疗胫骨平台外侧塌陷骨折,可有效防止关节面继发性塌陷,骨折解剖复位满意,膝关节功能恢复好,术后并发症少。
Objective To explore the efficacy of the proximal tibial lateral locking plate with rafting screws combined with Jail screws in the treatment of collapse fracture of the lateral tibial plateau.Methods A retrospective case series study was performed on clinical data of 36 patients with collapse fracture of the lateral tibial plateau admitted to Suqian Hospital of Nanjing Drum Tower Hospital Group from January 2016 to January 2020,including 19 males and 17 females,aged 34-68 years[(48.6±5.8)years].Schatzker classification was type II in 28 patients and type III in 8 patients.All patients were treated using the proximal tibial lateral locking plate with raft screws combined with Jail screws.The operation time,intraoperative blood loss and fracture healing were detected.The distance of articular surface collapse of the tibial plateau,posterior inclination angle(PSA)of the tibial plateau,tibial plateau varus angle(TPVA)and Rasmussen anatomical score were compared before operation and at day 2 and 1 year after operation.The Hospital for Special Surgery(HSS)score was used to evaluate knee function at day 2 and 1 year after operation.Complications were also recorded.Results All patients were followed up for 12-32 months[(19.5±3.1)months].The operation time was 56-82 minutes[(68.5±9.1)minutes].The intraoperative blood loss was 40-100 ml[(75.6±10.2)ml].The fracture was clinically healed by first-stage,with the healing time of 8 to 15 weeks[(12.5±1.3)weeks].The distance of articular surface collapse of the tibial plateau was improved from(15.5±4.2)mm before operation to(0.7±0.3)mm at day 2 after operation and(1.0±0.2)mm at 1 year after operation(all P<0.01).The PSA was improved from(21.2±2.1)°before operation to(8.9±0.8)°at day 2 after operation and(9.2±0.6)°at 1 year after operation(all P<0.01).The TPA was improved from(100.2±3.7)°before operation to(88.9±1.8)°at day 2 after operation and(87.2±1.6)°at 1 year after operation(all P<0.05).The Rasmussen anatomical score changed from(7.8±1.8)points before o
作者
孔祥如
杨春
单宇宙
孙健宁
姜伟
杨太明
朱裕成
Kong Xiangru;Yang Chun;Shan Yuzhou;Sun Jianning;Jiang Wei;Yang Taiming;Zhu Yucheng(Department of Orthopedics,Suqian Hospital Affiliated to Xuzhou Medical University,Suqian Hospital of Nanjing Drum Tower Hospital Group,Suqian 223800,China)
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2022年第6期510-516,共7页
Chinese Journal of Trauma
关键词
胫骨骨折
骨折固定术
内
锁定钢板
Tibial fractures
Fracture fixation,internal
Locking plate
