摘要
目的:比较胫骨外侧锁定接骨板+前侧拉力螺钉固定后外侧骨折块和胫骨外侧锁定接骨板+后外侧支撑接骨板固定骨折块治疗SchatzkerⅡ型胫骨平台骨折合并后外侧骨折的临床疗效。方法:回顾性分析2015年1月至2020年12月收治的33例SchatzkerⅡ型胫骨平台骨折合并后外侧骨折患者的临床资料,分为采用胫骨外侧锁定接骨板+前侧拉力螺钉固定治疗的前侧拉力螺钉组15例和采用胫骨外侧锁定接骨板+后外侧支撑接骨板固定治疗的后外侧支撑接骨板组18例。比较两组患者的手术时间、术中出血量、骨折愈合时间、美国特种外科医院(HSS)膝关节功能评分和Lysholm评分;通过Rasmussen放射学评分系统对术后即刻、术后6个月及术后12个月进行放射学评分。结果:两组患者术中均无血管神经损伤情况发生,术后均未发生内固定失效。前侧拉力螺钉组伤口未发生感染,均Ⅰ期愈合,2例复位关节面再次塌陷;后外侧支撑接骨板组出现2例伤口感染,未发生复位关节面再次塌陷情况。两组患者手术时间和术中出血量的差异有统计学意义(t=2.735,P=0.047;t=2.543,P=0.019)。后外侧支撑接骨板组在术后12个月随访时的HSS膝关节功能评分和Lysholm运动评分均优于前侧拉力螺钉组(t=2.315,P=0.026;t=2.251,P=0.024)。两组患者术后6个月和术后12个月的Rasmussen放射学评分有统计学意义(t=2.713,P=0.037;t=2.597,P=0.033)。结论:对于SchatzkerⅡ型胫骨平台骨折合并后外侧骨折的患者,通过尽量偏后放置胫骨外侧锁定接骨板、调整锁定钉方向来固定胫骨平台外侧柱和后外侧骨折块,同时加用前侧拉力螺钉来固定后外侧骨折块的效果欠佳;胫骨平台后外侧骨折使用支撑接骨板固定牢固,术后疗效满意,但需要术者对解剖知识掌握良好。
Objective:To explore the clinical efficacy of using lateral tibial locking plate combined with anterior lag screw fixation for the posterolateral fracture fragment and lateral tibial locking plate combined with posterior lateral support plate fixation for the fracture fragment in the treatment of Schatzker typeⅡtibial plateau fracture complicated posterolateral fractures.Methods:A retrospective analysis was conducted on the clinical data of 33 patients with SSchatzker typeⅡtibial plateau fracture complicated posterolateral fractures admitted from January 2015 to December 2020.The patients were divided into two groups:the anterior lag screw group(15 cases)treated with a surgical plan involving a lateral tibial locking plate and anterior tension screw fixation,and the posterolateral support plate group(18 cases)treated with a surgical plan involving a lateral tibial locking plate and posterolateral supporting plate fixation.The surgical time,intraoperative bleeding,fracture healing time,Hospital for Special Surgery(HSS)score,and Lysholm score were compared between the two groups.Rasmussen Radiological Scoring System was used to evaluate the radiological scoring at immediate post-operation,6 months,and 12 months post-operation.Results:There were no cases of vascular or nerve injury during the operation in either groups,and no cases of internal fixation failure occurred after the operation.There was no wound infection in the anterior lag screw group,with all wounds healed by primary intention,and two cases of reduction articular surface collapsed again;while two cases of wound infection occurred in the posterolateral support plate group,and there was no re-collapse of the reduction articular surface.There were statistically significant differences between the two groups in terms of operation time and intraoperative blood loss(t=2.735,P=0.047;t=2.543,P=0.019).The HSS knee function score and Lysholm motor score(t=2.315.P=0.026;t=2.251,P=0.024)in the posterior lateral support plate group were significantly higher than those in the anterior lag screw group(P<0.05).The Rasmussen radiology scores at the 6th month and the 12th month showed statistical significance between the two groups(t=2.713,P=0.037;t=2.597,P=0.033).Conclusions:For patients with Schatzker typeⅡtibial plateau fracture complicated posterolateral fractures,fixing the lateral tibial locking plate as posteriorly as possible and adjusting the direction of the locking screw to fix the lateral column of the tibial plateau and the posterolateral fracture fragments,and adding anterior lag screws to fix the posterolateral fracture,resulted in unsatisfactory effect.Using a support plate to firmly fix the posterolateral plateau fracture yielded satisfactory postoperative effect,but the operator is required to have a good basic knowledge of anatomy.
作者
程邦君
毛冯缘
黄燕峰
罗轶
何耀华
CHENG Bangjun;MAO Fengyuan;HUANG Yanfeng;LUO Yi;HE Yaohua(Department of Orthopedics,Jinshan Branch Hospital of the Sixth People's Hospital of Shanghai,Shanghai 201599;Clinical Medicine Major,Anhui Medical University,Hefei 230022;Department of Orthopedics,The Sixth People's Hospital of Shanghai,Shanghai 200233,China)
出处
《中华骨与关节外科杂志》
CSCD
2023年第11期1021-1027,共7页
Chinese Journal of Bone and Joint Surgery
基金
上海市金山区医药卫生类科技创新资金项目(2020-3-27)
上海健康医学院临床研究中心项目(20MC2020003)。
关键词
胫骨平台骨折
接骨板
Fracture of the Tibial Plateau
Internal Fixation Plate
作者简介
通信作者:黄燕峰,E-mail:huangyanfensh@163.com;通信作者:罗轶,E-mail:luoyii2005@126.com.
