后外侧入路撬拨复位简单内固定治疗胫骨后外侧平台塌陷性骨折

发布时间：2018-03-15 03:34

  本文选题：胫骨后外侧平台骨折　切入点：塌陷性骨折　出处：《中国修复重建外科杂志》2017年07期 　论文类型：期刊论文

【摘要】：目的探讨经后外侧入路有限切开、撬拨复位、简单内固定治疗胫骨后外侧平台塌陷性骨折的临床效果。方法 2010年10月—2016年1月,采用后外侧入路、撬拨复位、克氏针或螺钉等简单内固定治疗16例胫骨后外侧平台塌陷性骨折患者。男10例,女6例;年龄22~63岁,平均43.5岁。致伤原因:跌伤5例,交通事故伤7例,高处坠落伤4例。均为闭合性骨折。左膝9例,右膝7例。伤后至入院时间为2 h~3 d,平均10 h。X线片示关节面塌陷2 mm;根据Schatzker分型标准:Ⅱ型6例,Ⅲ型10例;其中12例合并腓骨头骨折。观察手术切口长度、手术时间、术中出血量、术后切口愈合情况;X线片观察骨折愈合情况,测量胫骨平台内翻角和后倾角;CT复查关节面复位及再次塌陷情况。膝关节功能根据美国特种外科医院(HSS)评分标准进行评价。结果手术切口长度为7~10 cm,平均8.6 cm;手术时间35~55 min,平均46 min;术中出血量10~35 m L,平均28 m L。术后切口均Ⅰ期愈合。1例术后2个月发生克氏针退针导致的针尾刺激皮肤疼痛。术后15例获随访,随访时间8~21个月,平均13.5个月。X线片复查示骨折均愈合,愈合时间3~6个月,平均4.8个月;术后即刻及1年时胫骨平台内翻角、后倾角比较差异均无统计学意义(t= 1.500,P=0.156;t= 1.781,P=0.097)。CT复查示术后即刻关节面解剖复位率为93.8%(15/16);末次随访时测量关节再次塌陷高度为0.1~1.2 mm,平均0.36 mm。末次随访时膝关节功能按HSS评分标准,获优12例、良2例、可1例,优良率为93.3%。结论经后外侧入路有限切开、撬拨复位、简单内固定治疗胫骨后外侧平台塌陷性骨折具有损伤小、暴露充分、手术操作简便、膝关节功能恢复满意等优点,植骨支撑、简单内固定可防止术后关节面再塌陷。
[Abstract]:Objective to investigate the clinical effect of limited incision, pry reduction and simple internal fixation through the posterolateral approach for the treatment of collapsed fractures of the posterolateral tibial plateau. Methods from October 2010 to January 2016, the posterolateral approach was used to pry the reduction. Simple internal fixation, such as Kirschner's needle or screw, was used to treat 16 patients with collapsing fracture of the posterior lateral tibial plateau. There were 10 males and 6 females, aged 22 to 63 years, with an average age of 43.5 years. The causes of injury were: 5 cases of falls and 7 cases of traffic accidents. There were 4 cases of falling injury at height, 9 cases of left knee and 7 cases of right knee. The average time from injury to admission was 2 hours and 3 days, with an average of 10 h. X ray film showed the articular surface collapse 2 mm, according to Schatzker classification criteria: type 鈪，

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