摘要
目的探讨经内侧入路单切口治疗胫骨平台后内侧骨折的手术疗效。方法选取我院2006年10月至2010年6月间经内侧入路治疗的胫骨平台后内侧骨折21例。取膝关节内侧切口显露胫骨平台内侧髁骨折块,撑开骨折间隙,C臂机监视下经此间隙撬拨,植骨填充复位外侧平台满意后以克氏针固定;直视下复位胫骨平台后内侧骨折,以4.5mm空心螺钉和支持钢板内固定。术后进行临床和影像学随访,随访终末行美国特种外科医院(the Hospital for Special Surgery,HSS)膝关节评分和骨关节炎Kellgren-Lawrence评分。结果 15例患者随访10～13个月,平均11.5个月。6例患者失访,剔除出组。术后即刻和随访终末的胫骨平台内翻角和胫骨内侧平台后倾角的差异无统计学意义(P>0.05)。随访终末时,屈膝100°～135°,平均122.3°;伸膝0°～7°,平均2.9°。膝关节HSS评分78～94分,平均86.8分;13.33%(2/15)患者为轻度骨关节炎;无感染、皮肤坏死、内固定松动或断裂等并发症发生。结论经内侧手术入路能够同时修复胫骨平台内侧髁骨折和后外侧平台塌陷骨折,坚强内固定可以充分防止力线改变和骨折再移位,治疗胫骨平台后内侧骨折疗效满意。
Objective To explore the medial operative approach for reconstruction and outcome of posteromedial tibial plateau fracture. Methods We selected 21 patients with posteromedial tibial plateau fracture in our hospital from Oct. 2006 to Jun. 2010. The medial condyle fracture was exposed following the fracture line to the articular border via medial approach. The posterolateral impaction was addressed directly through the main fracture gap from anteromedial to posterolateral, and preliminarily fixed with separate K-wire. Then the posteromedial fragment was reduced and applied with a buttress locking plate in the posteromedial position when the pes anserinus and medial collateral ligament were preserved. Clinical and radiological follow-up was performed. Evaluation criteria included the Hospital for Special Surgery （HSS） score and Kellgren-Lawrence score. Results A total of 15 patients acquired follow-up of 11.5 months on average （10 - 13 months）. Six patients with less than 3 months follow-up were removed from the study. There was no statistical difference between tibial plateau angle（TPA） and posterior slope angle （PSA） at the time points of immediate post-operation and follow-up terminal （P〉0.05）. At the follow-up terminal,the mean HSS score was 86.8 （78 - 94） ,and 13.33% （2/15） patients developed mild osteoarthritis according to the Kellgren-Lawrence system. No complication occurred, such as deep infection, necrosis of skin incision or loosening and breakage of internal fixators. Conclusions In our view,the medial approach for tibial plateau allows satisfactory repairing of posteromedial tibial plateau associated with a posterolateral depression of tibial plateau simultaneously.
出处
《复旦学报（医学版）》
CAS
CSCD
北大核心
2012年第2期172-175,193,共5页
Fudan University Journal of Medical Sciences
基金
上海市浦东新区卫生局课题(PW2008A-3
PW2011B-2)~~
作者简介
Corresponding author E-mail： Lizc. 2007@ yahoo, com. cn
