经后路加压螺钉内固定治疗胫骨平台后髁劈裂骨折

目的 探讨胫骨平台后髁劈裂骨折的手术方法.方法 取膝关节后内侧或后外侧入路,采用加压螺钉内固定治疗胫骨平台后髁劈裂骨折12例.结果 患者获得10～25个月的随访,骨折均获骨性愈合.根据Rasmussen膝关节功能评分法进行综合评分:优9例,良2例,可1例.结论 经膝关节后内侧或后外侧人路,采用加压螺钉内固定治疗胫骨平台后髁骨折,具有疗效确切、经济、创伤小、操作简单的特点.     

解剖型胫骨髁钢板治疗胫骨平台骨折

[目的]探讨胫骨平台骨折内固定的方法，评估内固定手术的疗效。[方法]对本科2000～2006年收治的22例胫骨平台骨折手术内固定患者进行随访，并进行回顾性分析，全部患者均采用德国LINK解剖型髁钢板内固定。[结果]本组患者平均随访33．3个月，骨折均于3个月愈合。膝关节功能恢复情况根据关节活动度、疼痛、关节稳定性进行HSS评分，平均89．5分。[结论]解剖型胫骨髁钢板可很好的治疗各型胫骨平台骨折，手术操作简单，治疗效果满意，是治疗胫骨平台骨折的良好的内固定材料。     

后侧入路拉力螺钉结合支撑钢板内固定治疗胫骨平台后髁骨折

目的探讨后侧入路拉力螺钉结合支撑钢板内固定治疗胫骨平台后髁骨折的疗效。方法收治12例该类骨折,均采用后侧入路拉力螺钉结合支撑钢板内固定治疗。结果 12例均获得随访,按照Rasmussen胫骨髁部骨折膝关节功能评分标准:优9例,良3例。结论后侧入路拉力螺钉结合支撑钢板内固定治疗胫骨平台后髁骨折,可以获得良好的显露、内固定可靠,是一种良好的治疗方法。     

胫骨平台后髁骨折前方入路手术治疗的影像及临床分析

目的分析胫骨平台后髁骨折的影像学特征,探讨前侧入路手术治疗胫骨平台后髁骨折的可行性及临床疗效。方法51例胫骨平台后髁骨折采用影像学检查分析骨折块大小,骨折线的角度以及合并膝关节内韧带、半月板等损伤情况。单纯后内侧骨折21例采用前内侧切口复位内固定,单纯后外侧骨折16例采用前外侧入路钢板结合拉力螺钉内固定,后内侧合并后外侧平台骨折14例采用前外侧切口结合前内侧切口或前正中切口外侧支撑钢板加内侧拉力螺钉或钢板内固定。结果 49例一期完成手术,手术时间平均95（50-160）min。51例均获随访8-48个月,平均21.5个月。末次随访时,Rasmussen影像学评分：优25例,良19例,可5例,差2例,优良率86.3%;Rasmussen功能评分：优13例,良28例,可5例,差5例,优良率80.4%。结论不同类型的胫骨平台后髁骨折具有影像学特异性,经前侧入路手术治疗胫骨平台后髁骨折具有可行性,并可同时处理合并的关节内软组织损伤,可获得良好的临床疗效。     

后内侧入路治疗胫骨平台后髁冠状位骨折的临床体会

[目的]探讨后内侧入路治疗胫骨平台后髁冠状位骨折的临床疗效,分析该类骨折损伤特点及手术入路的选择.[方法]自2008年1月～2011年7月对21例胫骨平台后髁冠状位骨折采用后内侧入路支撑钢板固定,男13例,女8例.年龄27 ～56岁,平均36.7岁,均为闭合性骨折.其中后内侧骨折6例,后外侧骨折7例,后内、后外侧同时累及8例.致伤原因:高处坠落伤3例,交通事故伤16例,运动损伤2例.[结果]本组19例获得随访,平均随访时间16.4个月(12～24个月),所有骨折在10 ～ 15周愈合,完全负重时间平均14.8周.根据Rasmussen评分系统评定膝关节功能,优12例,良5例,可2例,优良率89.5％.[结论]后内侧入路支撑钢板固定治疗胫骨平台后髁冠状位骨折固定牢靠,术后可早期行功能锻炼,并发症少,是理想的手术治疗方法.     

经膝关节后侧切口后内/外联合入路治疗胫骨平台后髁粉碎骨折

[目的]探讨胫骨平台后髁粉碎骨折的手术入路及操作技巧,总结其临床疗效.[方法]回顾性分析自2009年5月～2012年1月本科收治的胫骨平台后髁粉碎骨折11例,其中男8例,女3例;年龄21 ～53岁,平均36岁;左侧3例,右侧8例;受伤原因:交通事故伤9例,高处跌落伤2例.11例均合并不同程度胫骨内外侧平台骨折.所有病例采取膝关节后侧切口、后内/外侧联合入路、支撑钢板内固定治疗.[结果] 11例患者均顺利完成手术,无手术并发症发生;随访8 ～18个月,平均13个月,骨折均获骨性愈合,骨折愈合时间2～4个月,平均3个月,无骨折再塌陷及膝内外翻畸形发生.根据Rasmussen膝关节功能评分:优6例,良3例,可2例.[结论]经膝关节后侧切口、后内/外侧联合入路、支撑钢板内固定治疗胫骨平台后髁粉碎骨折手术直观、骨折复位固定效果好,无骨折再塌陷等临床并发症发生,获得优良的膝关节功能恢复.     

双切口入路治疗复杂胫骨平台骨折

目的探讨双切口入路在治疗复杂胫骨平台骨折中的应用效果。方法对21例复杂性胫骨平台骨折的患者采用前外侧联合后内侧切口。后内侧用有限接触加压钢板或窄加压钢板固定,外侧以支撑钢板固定。结果全部病例均获得随访,时间6-30个月。采用Rasmussen膝关节功能评分法评估疗效,优9例,良7例,可3例,差2例。术后无一例深部感染、内固定松动及断裂。结论双切口入路能有效减少软组织并发症,较好地显露骨折,复位方便,固定可靠,是一种较好的治疗复杂胫骨平台骨折的手术入路和方法。     

胫骨平台双髁骨折的手术治疗

目的探讨双切口入路固定治疗胫骨平台双髁骨折的临床疗效。方法2001年1月至2003年12月，采用外侧髌旁和后内侧联合切口固定治疗双髁骨折13例。按AO分型；C1型3例、C2型4例、C3型6例，后内侧用3.5mm有限接触加压钢板，外侧用“高尔夫”型钢板固定。结果13例患者均获得随访，术后随访时间为12～25个月，平均l6个月。骨折均在12周内愈合，Sanders膝关节评分评定结合为优5例，良7例、可1例。本组病例均恢复了患肢的正常力线和患膝稳定，术后无1例发生深部感染、内固定松动及断裂。结论采用外侧髌旁和后内侧双切口人路治疗胫骨平台双髁骨折，固定稳定，并发症少，关节功能满意。     

双钢板法治疗胫骨平台双髁骨折

目的探讨双钢板法治疗胫骨平台双髁骨折的临床疗效。方法从2002年3月～2004年6月在我院采用双钢板法治疗胫骨平台双髁骨折19例,其中男14例,女5例;平均39.4岁(28～52岁);左膝12例,右膝7例。按Schatzker分型:Ⅴ型8例,Ⅵ型11例。按AO分型:C1.3型11例,C2.3型6例,C2.4型2例。采用内、外侧两个切口,外侧为胫骨平台标准入路———外侧髌骨旁入路,内侧为胫骨后内侧入路;行双钢板固定:内侧用一块四孔1/3半管型接骨板或前臂小钢板固定,外侧异形钢板固定。结果术后16例获得随访,随访4～31个月,平均15个月。按照Rasmussen[1犦的标准评价膝关节功能:优11例,良5例,差3例,优良率为84.2%。结论双切口双钢板技术具有手术创伤小,切口及软组织并发症明显减少,骨折固定长期的稳定性良好,可以早期行CPM机锻炼,关节功能恢复满意等优点,是治疗胫骨平台双髁骨折安全、有效的方法。     

经后外侧入路治疗胫骨平台单纯后外侧骨折

胫骨平台后外侧骨折是胫骨平台骨折的一种特殊类型,它是指胫骨平台骨折单纯累及后外侧髁,通常表现为后外侧关节面的塌陷或合并后外侧皮质的劈裂.这种类型的骨折是在膝关节屈曲时由较小的轴向暴力所致[1-2].治疗上采用骨折块后侧的支撑钢板固定最为可靠,但由于骨折块位置偏后外侧,通过经典的手术入路难以直接暴露骨折部位,无法直视下复位和安放支撑钢板.2007年5月至2008年12月我们采用自行设计的膝关节后外侧入路结合后侧支撑钢板内固定的方式治疗了12例胫骨平台单纯后外侧骨折的病例,经随访效果满意.     

Treatment of complicated tibial plateau fractures with dual plating via a 2-incision technique

The operative treatment of complicated bicondylar fractures of the tibial plateau remains a challenge to most surgeons. This retrospective study was designed to evaluate the clinical and radiological outcomes of dual plating via a 2-incision technique for the repair of complicated bicondylar tibial plateau fractures. A series of consecutive patients with bicondylar tibial plateau fractures treated by open reduction and internal fixation with a double buttress plate or a combination of locking plate and buttress plate via a 2-incision technique between March 2004 and March 2008 were retrospectively analyzed. Radiological and clinical results and complications of the 2 different fixation methods were compared. Seventy-nine patients matching the criteria of this study were followed up for at least 24 months. All of the fractures healed, with 3 cases of deep infection, 7 cases of secondary loss of reduction, 3 cases of secondary loss of alignment, and 10 cases of knee instability. At 24-month follow-up, mean Hospital for Special Surgery scores were 77.8±9.4 and 79.0±7.9 in the double buttress plate group and combination group, respectively. No significant differences in clinical or radiographic outcomes were found between the 2 groups, except that the combination group needed less bone graft. Dual plating with 2 incisions provided good exposition for the reduction and fixation of complicated bicondylar tibial plateau fractures. Using a combination of locking plate and buttress plate reduced the amount of bone graft compared with the double buttress plate technique.     

林可钢板并植骨治疗胫骨平台骨折

[目的]探讨Link胫骨上段解剖钢板固定治疗胫骨平台骨折的手术方法及疗效评估。[方法]本院19％年1月-2004年7月住院患者128例，按胥少汀分类，Ⅱ型92例，Ⅲ型36例。均经手术治疗行单侧骨膜剥离，对平台骨折并塌陷者，在保持关节面平整基础上行坚强内固定并植骨，早期膝关节功能锻炼。[结果]所有病例均获6个月～18个月的随访，全部病例均骨性愈合，愈合时间最短为8周，最长为14周，平均为12周，膝关节功能评价，优108，占84．38％，良16例，占12．50％，可4例，占3．12％，优良率为96．88％。[结论]Link钢板加植骨治疗胫骨平台骨折，对加快骨折愈合，防止胫骨平台塌陷，便于膝关节早期功能锻炼，预防关节僵直和创伤性关节炎有显著疗效。     

Bicondylar tibial plateau fractures: principles of treatment

The management of intraarticular fractures such as tibial plateau fractures in weightbearing joints is inherently complex. Bicondylar tibial plateau fractures resulting from high energy trauma are particularly difficult to treat successfully. The objectives in managing these fractures are to obtain adequate reduction and appropriate stabilization while allowing early range of motion and limiting potential morbidity. The incidence of complications and long-term sequelae is relatively high in cases treated with traditional open reduction and internal fixation. From 1986 through 1993, 32 bicondylar tibial plateau fractures were treated at our institution. Of these, 26 were treated operatively using various methods of open reduction and internal fixation, and, more recently, indirect reduction techniques with percutaneous screw and/or external fixation. These newer techniques include arthroscopically-assisted reduction with percutaneous screw fixation or applications of a hybrid circular external fixator with or without limited internal fixation. These techniques provide adequate reduction and fixation while limiting the complications associated with traditional open methods. This retrospective study was conducted to compare these newer techniques with more traditional methods of open reduction and internal fixation (ORIF).     

胫骨远端锁定加压钢板治疗Pilon骨折的疗效分析

目的 分析应用胫骨远端锁定加压钢板治疗粉碎性Pilon骨折的疗效。方法 胫骨远端锁定加压钢板治疗14例Pilon骨折患者,腓骨作外侧偏后纵切口,复位后用1／3管型或重建钢板固定。胫骨作有限切开复位后,用胫骨远端锁定加压钢板经皮下插入,锁定螺钉固定。结果 14例均获随访,时间7—24个月。采用Mazur评分系统评估手术疗效,优5例,良6例,可3例,无切口裂开和深部感染发生。结论 对粉碎性Pilon骨折选用胫骨远端锁定加压钢板内固定能获得优良疗效。     

截骨复位治疗胫骨外侧平台压缩性骨折

目的探讨胫骨外侧平台压缩性骨折的治疗方法。方法 2002年1月至2008年12月采用截骨复位、植骨内固定治疗胫骨平台压缩性骨折32例。结果 32例患者获得12～24个月随访,平均随访时间15个月。随访12个月膝关节功能按Rasmussen标准评分,优21例,良9例,可2例,优良率达93.8%。比较术后即刻与随访12个月时胫骨平台塌陷高度、增宽宽度及外倾角,差异无统计学意义（P〉0.05）。无螺钉松动、断裂及内固定失败等并发症发生。结论截骨复位法治疗胫骨外侧平台压缩性骨折,具有直视下易于将关节面整复到正常形态和高度、术中形成骨缺损区域小、植骨量少以及易于植入和植实等优点,尤其对于平台边缘有压缩性骨折及伴有胫骨平台增宽的病例,这种手术方法更具实用性。     

Bicondylar tibial plateau fractures treated with fine-wire circular external fixation

Bicondylar tibial plateau fractures are serious injuries to a major weight-bearing joint. These injuries are often associated with severe soft tissue injuries that complicate surgical management. We reviewed 54 consecutive patients who sustained bicondylar tibial plateau fractures that were treated with limited open reduction and cannulated screw fixation combined with fine-wire circular external fixation. Forty-six patients met the inclusion criteria of this retrospective review. Eight patients were excluded because they did not complete a minimum of 1-year follow-up. Thirty-six patients had Schatzker type-VI, and ten patients had Schatzker type-V fractures. All fractures were united without loss of reduction; there were no incidences of wound complications, osteomyelitis or septic arthritis. The average Knee Society Clinical Rating Score was 81.6, translating to good clinical results. Minor pin track infection was the most common complication encountered. This review concludes that fine-wire circular external fixation, combined with limited open reduction and cannulated screw fixation, consistently produces good functional results without serious complications.     

Posterior bicondylar tibial plateau fractures

OBJECTIVE: To present a case series of patients with posterior bicondylar tibial plateau fractures treated by direct fracture exposure and fixation through dual incisions. DESIGN: Retrospective clinical study. SETTING: Level 1 trauma centers. PATIENTS/PARTICIPANTS: Eight patients were identified that had posterior bicondylar tibial plateau fractures. Two patients had depressed posterolateral tibial plateau fractures with contained defects and did not have direct fracture exposure. One patient died of medical problems leaving 5 patients who underwent direct fracture exposure, reduction, and fixation. INTERVENTION: Posteromedial followed by posterolateral open reduction and internal fixation of posterior bicondylar tibial plateau fractures. RESULTS: At 6 to 24 months follow-up (mean 13 months), all patients returned to near full activities, each with aching after prolonged standing (8-hour shift). Range of motion averaged 2 degrees to 121 degrees of flexion. Three of 5 returned to manual labor jobs; the others were not employed at the time of injury. CONCLUSIONS: Posterior bicondylar tibial plateau fractures have a high association with lateral meniscal pathology and can be associated with anterior cruciate ligament injury. Reduction of the posterior plateau condyles is easiest with the knee in full extension. Flexion contractures can be a problem, and patients should be encouraged to regain/maintain knee extension. The dual-incision approach to these challenging fractures can result in good to excellent knee function for these patients.     

Proximal tibial fractures: early experience using polyaxial locking-plate technology

Between 2004 and 2009, 60 patients with proximal tibial fractures were included in this prospective study. All fractures were treated with the polyaxial locked-plate fixation system (DePuy, Warsaw, IN, USA). Clinical and radiographic data, including fracture pattern, changes in alignment, local and systemic complications, hardware failure and fracture union were analysed. The mean follow-up was 14 (12–36) months. According to the Orthopaedic Trauma Association (OTA) classification, there were five 41-A, 28 41-B and 27 41-C fractures. Fractures were treated percutaneously in 30% of cases. Double-plating was used in 11 cases. All but three fractures progressed to union at a mean of 3.2 (2.5–5) months. There was no evidence of varus collapse as a result of polyaxial screw failure. No plate fractured, and no screw cut out was noted. There was one case of lateral joint collapse (>10°) in a patient with open bicondylar plateau fracture. The mean Knee Society Score at the time of final follow-up was 91 points, and the mean functional score was 89 points. The polyaxial locking-plate system provided stable fixation of extra-articular and intra-articular proximal tibial fractures and good functional outcomes with a low complication rate.     

复杂胫骨平台骨折的手术治疗

目的　探讨复杂胫骨平台骨折的治疗方法。方法　自 1993年 1月～ 1999年 6月收治复杂胫骨平台骨折 5 9例 ,均经切开复位、“AO”T型支撑钢板内固定。结果　随访 1年～ 5年 ,共 47例 ,优良率 89 36 %。结论　复杂胫骨平台骨折应当考虑手术治疗。MRI检查有助于全面评价骨折区域的整体情况 ;必须早期处理受损的软组织 ;在手术中 ,压缩的骨折块应整块上抬复位 ,而钢板与螺钉的置入方法相当重要 ,其它稳定结构应予修复并于术后早期作功能训练