关节镜下撬拨复位经皮固定治疗胫骨平台骨折

目的探讨关节镜下撬拨复位经皮固定治疗胫骨平台骨折的疗效. 方法 1999年4月～2002年6月,17例胫骨平台骨折在关节镜下通过撬拨复位植骨重建塌陷的胫骨平台,并经皮用松质骨螺钉固定. 结果 17例术后3个月都达到临床骨愈合.无感染和严重骨关节炎等并发症. 结论关节镜下撬拨复位经皮固定治疗胫骨平台骨折,复位直观、固定可靠,有利于早期功能锻炼.     

关节镜监控下经皮内固定处理胫骨平台骨折

目的 对关节镜监控下经皮内固定和切开复位内固定处理的胫骨平台骨折的结果作评估.方法 对随访时间超过1年的53例SchatzkerⅠ、Ⅱ、Ⅲ型胫骨平台骨折进行了回顾性研究.其中,23例接受关节镜手术(S组),30例接受开放手术内固定术(O组).结果 两组在手术时间、膝关节活动度、Rasmussen功能评分方面差异无统计学意义;但S组膝关节屈曲到120°的平均时间早于O组[S组8.3±2.3周;O组(10.9±3.0)周];S组病人的平均住院时间短于O组病人[S组(6.1±1.8) d;O组(9.3±1.9) d].结论 关节镜监控下经皮内固定处理SchatzkerⅠ型、Ⅱ型、Ⅲ型胫骨平台骨折可以获得良好的近、中期效果,是值得推荐的一种手术方法.     

关节镜监视下复位固定治疗AO-B型胫骨平台骨折

近年来,随着关节镜技术的不断发展和完善,关节镜监视下胫骨平台骨折的复位内固定愈来愈受到重视.在骨折获得良好复位的同时,关节镜技术对关节内其他结构的诊治具有重要作用,这是其他治疗方法无法比拟的[1].2004年6月至2006年12月,我院采用关节镜监视下复位内同定治疗23例AO-B型胫骨平台骨折患者,疗效满意,现报告如下.     

有限切开间接复位治疗简单胫骨平台骨折:应用C型臂X线机透视与关节镜监视两种方法的比较

目的探讨应用C型臂X线机透视和应用关节镜监视对简单胫骨平台骨折有限切开间接复位治疗的效果比较。方法采用有限切开间接复位技术治疗58例简单胫骨平台骨折,其中31例在C型臂X线机透视下完成(C型臂组),27例在关节镜监视下完成(关节镜组)。比较两种治疗方法在手术时间、软组织合并伤、术后早期并发症、内固定失败、膝关节功能(Hohl和Lcuk膝关节评分)等指标的差异。结果两组患者手术时间比较,差异有统计学意义(P<0.05)。两组患者术后早期并发症、内固定失败、膝关节功能评分等指标比较,差异无统计学意义(P>0.05)。结论对简单胫骨平台骨折行有限切开间接复位固定在应用C型臂X线机透视和应用关节镜监视指导下均能取得良好的治疗效果。C型臂X线机透视指导下复位结合有限切开间接复位内固定技术仍是治疗简单胫骨平台骨折的主要治疗手段,特别适合在不具备关节镜设备的县级以下基层医院开展。应用关节镜指导操作较应用C型臂X线机透视指导操作要相对复杂,手术时间长,需要专门训练。     

Indirect reduction and percutaneous screw fixation of displaced tibial plateau fractures.

Indirect reduction and percutaneous screw fixation were attempted in 20 displaced tibial plateau fractures in 20 patients. Closed, indirect reduction was successful in 18 fractures; two others, both Schatzker type II fractures, required open reduction. The 18 fractures were followed for an average of 16.2 months (range, 12-24 months). Of the fractures successfully reduced with indirect techniques, 13 were reduced anatomically (72.2%), and five were considered nonanatomic (27.8%). Four of the five fractures with a nonanatomic reduction were type II fractures. Clinically, there were six excellent (33%), 10 good (56%), and two fair (11%) results. No fracture lost reduction; no patient developed an infection. Indirect techniques could effectively reduce only split fragments. Depressed fragments could not be reduced reliably with either ligamentotaxis or percutaneous elevation with a tamp. There was no correlation between radiographic reduction and clinical outcome. It did not matter whether two, three, or four screws were used to stabilize the fracture.     

关节镜辅助复位内固定与切开复位内固定治疗胫骨平台骨折的疗效比较

目的:比较关节镜辅助复位内固定（ARIF）和切开复位内固定（ORIF）治疗胫骨平台骨折的疗效。方法:回顾性分析2016年1月至2018年8月华中科技大学附属协和医院骨科收治的75例胫骨平台骨折患者的资料。男58例,女17例;年龄20~54岁,平均47岁。左侧42例,右侧33例。骨折根据Schatzker分型：Ⅰ型23例...     

Open reduction and internal fixation of 117 tibial plateau fractures

This retrospective study evaluated the surgical management of 117 tibial plateau fractures treated between 1990 and 1998. At last patient follow-up, results were rated good to excellent in 94, fair in 13, and poor in 10 cases. Follow-up radiographs showed degenerative changes in the lateral compartment in 29 cases. Other complications included five wound infections, two deep venous thromboses, five delayed unions, and three nonunions. Operative treatment of tibial plateau fractures is recommended as it enables better alignment, meniscal access, and other soft-tissue injury repair.     

Closed reduction and percutaneous fixation of anterior column acetabular fractures.

OBJECTIVE: The current standard treatment of anterior column acetabular fractures includes formal open reduction with internal fixation (ORIF) through a variety of anterior approaches. These approaches have been associated with significant blood loss, infection, lengthy operative times, and neurovascular complications. It therefore seems reasonable to consider less invasive alternatives to conventional treatment methods. A technique for percutaneous reduction and fixation of a particular acetabular fracture pattern is presented. Execution of this technique has been facilitated by the use of image-guided surgical navigation. MATERIALS AND METHODS: A retrospective review was performed on 23 patients who had suffered an acute anterior column fracture of the acetabulum (OTA 62-A3.2, 62-A3.3, 62-B3.2, 62-B3.3) managed with closed reduction and internal fixation using large-bore cannulated screws over an 11-year period. An additional three patients treated during the study period underwent formal ORIF with plates and screws after failure of attempted closed reduction, and were not included in this analysis. Eight of the 23 patients had an associated posterior hemitransverse fracture that was also managed with minimally invasive fixation. A variety of surgical navigation techniques were used to allow accurate percutaneous screw placement: CT-guided percutaneous fixation was performed in 10 patients (1990-1995); fluoroscopy alone was used in four patients (1995-1998); and computer-assisted virtual fluoroscopy was used in nine patients (1999-2002). Some fractures were nondisplaced but potentially unstable, and involved the superior weight-bearing dome; others required closed manipulation using Schanz-pin joysticks placed into the iliac wings and held in place with a temporary external fixator. One patient required a limited open reduction followed by percutaneous screw fixation. After confirmation of adequate reduction, one to three large-bore cannulated screws were placed percutaneously using previously defined safe trajectories. All patients were managed postoperatively with early mobilization and physical therapy. RESULTS: The average preoperative and postoperative displacements were 8.9 and 2.4 mm, respectively. No patient had a loss of reduction during healing. As experience was gained with the computer-assisted imaging, total fluoroscopy times were as little as 6 s, and were routinely kept below 45 s. None of the patients experienced infection, significant blood loss, or iatrogenic neurologic or visceral injury. No symptomatic heterotopic ossification was noted. Of those patients available for follow-up at a minimum of 2 years, the average HSS self-administered hip score was 91. CONCLUSION: We believe that our findings substantiate percutaneous reduction and internal fixation of anterior column acetabular fractures as a safe and effective alternative to formal ORIF, with a low anticipated complication rate and excellent outcome.     

Open reduction and internal fixation of high-energy tibial plateau fractures

Proximal tibial articular fractures are caused by a variety of mechanisms and are characterized by numerous distinct fracture patterns. Surgical treatment for other than minimally displaced or nondisplaced fractures is recommended to restore joint congruity and limb alignment, and to allow early, stable, knee motion.     

Open reduction and internal fixation versus hybrid fixation for bicondylar/severe tibial plateau fractures: a systematic review of the literature

Introduction  Bicondylar/Schatzker 6 type tibial plateau fractures are a significant challenge to the trauma and orthopaedic surgeon. These injuries tend to be complex, high energy and are activated with significant morbidity. Two surgical methods are commonly in use: (1) hybrid external fixation or (2) internal fixation. We performed a systematic analysis of papers comparing these two techniques. Methods  The Medline database was used and the MeSH terms associated with bicondylar/severe tibial plateau fractures were inserted. Results  Forty-nine studies were retrieved but only five papers presented data to directly compare the two techniques as these studies actually compared the implants. Study designs and outcome measures were not consistent in all studies and therefore no direct comparison could be made between the papers. The first two studies were laboratory based and suggested that hybrid external fixation may have a benefit over internal fixation with respect to failure load and its use in compromised bone. Two further papers presented only type 4 evidence. The final paper was a multicentre randomised controlled trial and it demonstrated a marginal non-significant benefit of hybrid external fixation over internal fixation although there was suggestion of beta error [i.e. accepting the hypothesis when it is not true]. Conclusion  Bicondylar/Schatzker 6 type fractures are difficult to manage. The treatment of such fractures, need to pay specific attention to the soft tissue envelope around the knee. Hybrid external fixation has theoretical advantages in terms of the soft tissues but the benefit over internal fixation is modest at best and has not demonstrated improved outcome. Newer fixed angle screw and plate systems are increasingly in use and need comparative studies to determine their role in this complex group of fractures.     

顶撬植骨内固定治疗胫骨平台压缩骨折

对胫骨平台压缩骨折采用手术治疗还是保守治疗,目前尚有争议。我院1996年4月～1999年10月收治胫骨平台骨折53例,其中27例胫骨平台压缩骨折采用顶撬植骨内固定手术治疗,获得较满意的疗效。1　材料与方法1.1　病例资料　本组27例,男20例,女7例。年龄21～70岁。致伤因素:交通伤15例,高处坠落伤4例,砸伤8例。合并伤:内侧副韧带损伤5例,外侧副韧带损伤2例,半月板损伤2例,后交叉韧带损伤2例,前交叉韧带损伤1例,多发性骨折3例。骨折分型:按ＡＯ分型〔1〕,Ｂ2型16例,Ｂ3型11例。1.2　手术方法　连续硬膜外麻醉,仰卧位。依据骨折塌陷的部位,选择外侧…     

关节镜下经皮可吸收螺钉内固定治疗胫骨平台骨折

<正>胫骨平台骨折是较为常见的关节内骨折,可以导致关节面应力分布不稳定、关节疼痛和功能障碍等。另外,胫骨平台骨折常伴发半月板及韧带损伤,因此进行详细检查和治疗极为重要。采用关节镜术中检查并辅助进行经皮可吸收螺钉内固定,可减少手术创伤,避免二次手术。我院自2003年以来采用关节镜辅助下经皮可吸收螺钉内固定治疗SchatzkerⅠ～Ⅳ型胫骨平台骨折23例,均取得良好效果,现报告如下。     

Arthroscopic reduction and internal fixation of tibial plateau fractures in skiing

Arthroscopic reduction and internal fixation of tibial plateau fractures can facilitate restoration of articular congruity while permitting rigid fracture stabilization. Twenty-five patients who underwent arthroscpoic reduction and internal fixation of a tibial plateau fracture were reviewed. The average age of the patients was 45. At a mean followup of 24 months, 76% of patients rated their result as excellent and 16% as good. Eighty-four percent returned to full sporting activity. There were no episodes of nonunion, failure of fixation, wound infection, deep venous thrombosis, compartment syndrome, or arthrofibrosis. Preoperative fracture depression averaged 7.7 mm (range, 1-18 mm). Fracture depression at final followup averaged 0.8 mm (range, 0-5 mm). Sixty-four percent of patients had associated intraarticular injury diagnosed and treated at the time of arthroscopy. Arthroscopic reduction and internal fixation provides an accurate assessment of, and allows definitive treatment for, intraarticular injuries associated with tibial plateau fractures. The technique allows less soft tissue stripping than with traditional arthrotomy, better visualization of the articular surface, early return to physical activities, and obviates the need for meniscal detachment and repair.     

Percutaneous screw fixation of tibial plateau fractures.

A series of 13 patients with displaced fractures of the tibial plateau treated by closed reduction and percutaneous pinning have been reviewed 17 months after surgery. All the operations were performed using image intensification to aid reduction of the fracture by ligamentotaxis and to guide screw placement. In two cases, arthroscopy was used in addition to facilitate elevation of the articular surface using a probe inserted through a cortical window in the proximal tibial metaphysis. The postoperative rehabilitation programme consisted of early mobilization and non-weight bearing for at least 2 months. Of the patients, 11 had a satisfactory result, one patient had a fair result with persistent pain and the other had a poor result when the fixation failed in a comminuted bicondylar fracture in porotic bone. This technique is minimally invasive and avoids many of the complications of both conservative and operative treatment and will have an expanding role to play in the management of these fractures.     

Closed reduction of tibial plateau fractures. A comparison of functional and roentgenographic end results

One hundred tibial plateau fractures in 96 patients were treated at three teaching hospitals. Seventy-three fractures were treated by closed reduction and early mobilization of the knee using a cast brace. Twelve fractures in this group also had percutaneous pin fixation under fluoroscopic control. The end results were graded by clinical functional criteria and by roentgenographic criteria. Eighty-nine percent of the patients treated by closed reduction methods had good to excellent functional results with a low complication rate (12%). Observations based on long-term roentgenographic examinations did not correlate with the functional end results. Many patients with less than satisfactory roentgenographic results had good to excellent functional long-term results. The indications for operative stabilization of these fractures should be based on testing for knee stability in full extension, rather than on any arbitrary roentgenographic criteria. For unstable fractures, closed reduction using ligamentotaxis and percutaneous fixation supplemented by cast brace support proved effective and relatively free of complications.     

胫骨平台骨折关节镜监视下复位内固定与切开复位内固定的疗效比较

目的比较关节镜监视下复位内固定与切开复位内固定方法治疗胫骨平台骨折的临床效果。方法2005年4月至2009年4月共收治48例胫骨平台骨折。分为切开复位内固定组22例（A组）,其中男13例,女9例,关节镜监视下复位内固定26例（B组）,其中男15例,女11例,术后随访12—24个月（平均15．3个月）,切口长度、住院时间评价手术效果,Rasmussen胫骨平台骨折影像学评分系统评定骨折复位满意程度,Rasmussen评分系统评价膝关节的功能,x线评价骨折愈合效果。结果48例均获随访,切口长度A组（15．3±2．4）cm,B组（9．7±1．9）cm,住院时间A组（18．3±1．5）d,B组（11．8±2．1）d,两组差异有统计学意义（t1=6．32,P,〈0．05;t2=3．34,P1〈0．05）,术后6个月Rasmussen胫骨平台骨折影像学评分A组优良率83．5％,B组94．9％,术后1年Rasmussen评分A组优良率82．7％,B组93．5％,两组差异有统计学意义。结论关节镜监视下复位内固定胫骨平台骨折手术创伤小、住院时间短、骨折复位满意、膝关节功能恢复较好,而且关节镜能早期发现和处理半月板及交叉韧带的损伤,是一种安全、可行的微创治疗手段。