胫骨平台外侧髁塌陷分离骨折的手术治疗

目的：探讨胫骨平台外侧髁塌陷分离骨折复位困难的原因及手术方法。方法：自2003年1月至2008年10月,采用外侧切口显露外侧半月板外侧缘,复位半月板后再复位平台外髁,对45例胫骨平台外髁塌陷分离骨折进行手术治疗。男27例,女18例;年龄15～76岁,平均37岁。伤后至就诊时间1～14d,所有患者X线片提示胫骨平台外髁塌陷超过2mm或增宽大于5mm。术后采用Rasmussen评分标准评定关节功能,并通过观察患膝有无疼痛,关节活动度,有无感染、下肢深静脉血栓、关节面再塌陷并发症指标对疗效评估。结果：术后X线片示骨折解剖复位31例,近解剖复位14例,钢板螺钉位置均满意。45例中42例得到随访,时间6～12个月,平均10个月。解除外固定后无骨折再移位,无术后感染、下肢深静脉血栓发生,均在10d左右骨折部疼痛消失,3周后无压痛及纵轴叩击痛,3个月后X线提示所有病例骨折完全愈合。据Rasmussen评分标准优37例,良7例,尚可1例。结论：外侧半月板及塌陷骨块嵌顿是导致胫骨平台外髁复位困难的两大因素。

Operative treatment of collapse separation fractures of lateral tibial condyle

Objective: To investigate the treatment method for collapse separation fractures of lateral tibial condyle. Methods: From January 2003 to October 2008,45 patients with collapse separation fractures of lateral tibial condyle were treated by surgical method,including 27 males and 18 females,ranging in age from 15 to 76 years,with an average of 37 years. The duration from injury to operation ranged from 1 to 14 days. All of the patients preoperatively underwent X-ray examinations in order to accurately understand the extent of fracture and fracture collapse. All of the 45 fractures with collapse more than 2 mm and widen more than 5 mm were selected for surgical treatment. The lateral surgical approach was used to expose the lateral margin of the lateral meniscus first,and then the reduction of the lateral meniscus and lateral condyle were achieved. The results after operation were evaluated by the Rasmussen criteria,as well as the complications of the knee joint pain,the joint activity,the infection,deep venous thrombosis and recurrent fracture collapse. Results: Postoperative X-ray showed anatomical reduction was achieved in 31 patients,14 patients got nearly anatomical reduction. The plate and screw position were satisfactory. Forty-two patients were followed up,and the duration ranged from 6 to 12 months,with an average of 10 months. Fracture re-displacement,postoperative infection and deep venous thrombosis did not occur after the lifting of external fixation. All the patients had pain disappeared about 10 days after operation,and had no vertical axis percussion tenderness at 3 weeks after operation. The X-ray showed fractures was healed in all patients at 3 months after operation. Joint activity Rasmussen assessment criteria Results: 37 patients got an excellent result,7 good,1 poor. Conclusion: The incarceration of lateral meniscus and the collapsed bone fragments are two factors which make the reduction of the lateral tibial condyle difficult.