胫骨平台伴髁间嵴骨折手术治疗的临床疗效

目的：探讨开放复位内固定治疗胫骨平台伴髁间嵴骨折的临床疗效。方法2007年6月～2011年6月对收治的42例胫骨平台伴髁间嵴骨折采用切开复位钢板内固定治疗,同时行钢丝固定髁间嵴骨折36例,6例未固定。胫骨平台骨折按Schatzker分型：Ⅲ型8例,Ⅳ型18例,Ⅴ型10例,Ⅵ型6例;胫骨髁间嵴骨折按Meyers McKeever分型：Ⅰ型6例,Ⅱ型17例,Ⅲ型13例,Ⅳ型6例。结果术后1例切口发生脂肪液化并感染,经清创、负压吸引及II期缝合后愈合,余伤口均Ⅰ期愈合。随访12～26个月,平均18个月。末次随访时,患者膝关节伸直均达到0°,屈膝80°～150°,平均122°;膝关节稳定性检查：3例Lachman试验及前抽屉试验（ ADT）为阳性;参照Rasmussen膝关节功能评分标准：优16例,良19例,可4例,差3例;优良率为83.3％。7例发生膝关节创伤性关节炎,3例胫骨髁间嵴骨折未愈合。结论手术治疗胫骨平台伴髁间嵴骨折应重视对髁间嵴骨折的固定,包括无移位的髁间嵴骨折,有利于术后早期功能锻炼及维持膝关节稳定。     

关节镜下治疗胫骨髁间棘骨折

目的探讨关节镜下复位并内固定治疗胫骨髁间棘骨折的手术方法及疗效。方法对14例Meyers-MckeeverⅡ、Ⅲ、Ⅳ的胫骨髁间棘骨折患者施行关节镜下复位及内固定术。在关节镜监视下,对移位或翻转的粉碎骨折块进行复位,用不可吸收缝合线或自攻空心松质骨螺钉对骨折块行内固定,同时处理合并伤。术后使用支具于伸膝位制动4～6周,术后给予相应阶段的康复指导。结果全部患者术后骨折愈合良好,伤膝关节活动度与健侧一致,关节稳定。结论对于胫骨髁间棘骨折,根据患者年龄、骨折类型、选取适合的内固定方式,在关节镜监视下完全可以做到满意的骨折整复,可靠的内固定,重建前交叉韧带的稳定性。关节镜下复位、内固定手术创伤小,较膝关节开放手术具有明显优越性。     

Adult tibial intercondylar eminence fracture: evaluation with MR imaging

Tibial intercondylar eminence (TIE) fractures are well described in the pediatric orthopedic literature. Adult TIEs are much less common, and limited literature exists on the subject. Adult knee hyperextension injuries commonly result in anterior cruciate ligament (ACL) injury; however, with significant trauma, a TIE enters the differential diagnosis. Identification and classification of TIE fractures typically has been provided by radiography. The incidence of concomitant injuries with magnetic resonance (MR) imaging in patients with adult TIE fractures has not been determined. We present a case of an adult type III TIE fracture seen on radiography that only with further MR imaging revealed a concomitant lateral tibial plateau fracture. Utilization of MR imaging altered the surgeon's course of treatment and postoperative care. Radiographic and MR images and a review of the literature are provided.     

关节镜辅助下胫骨嵴撕脱骨折的治疗

对36例胫骨嵴撕脱骨折患者的病历资料进行回顾性分析.认为关节镜辅助下治疗胫骨嵴撕脱骨折具有手术创伤小、操作方便、固定可靠、术后康复快、并发症少等优点,同时可以发现并处理关节内合并伤.     

成人胫骨髁间棘撕脱骨折手术治疗的疗效分析

目的 探讨成人胫骨髁间棘撕脱骨折的特点与不同手术方法的疗效.方法 回顾性分析1997年5月-2005年6月31例胫骨髁间棘撕脱骨折患者31例,其中Meyers-McKeeverⅡ型5例,Ⅲ型12例,ZaricznyiⅣ型14例;合并内侧副韧带(MCL)损伤12例,合并胫骨平台骨折10例.包括切开复位内固定(A组)17例和关节镜下复位内固定(B组)14例,进行平均2.9年的随访.结果 两组不同程度伸膝功能异常23例,屈膝功能异常13例.其中A组伸膝功能异常12例,B组异常11例,A组屈膝功能异常8例,B组异常5例.Lachman和前抽屉试验结果A组分别为(1.59±0.44)°和(1.36±0.66)°,B组分别为(1.65±0.45)°和(1.57±0.88)°.A、B两组轴移试验分别为(0.7±0.3)°和(0.8±0.3)°.KT-2000检查前交叉韧带松弛的健侧患侧差别A、B两组分别为(1.5±1.3)mm和(1.7±2.4)mm;Lysholm评分为(96.5±3.3)分和(95.6±3.8)分;Tegner评分为(6.3±0.5)分和(6.2±0.6)分,上述各种指标组间比较差异均无统计学意义(P＞0.05).结论 成人髁间棘撕脱骨折多为粉碎性骨折,容易合并MCL损伤和胫骨平台骨折.手术方法要根据骨折类型、设备条件和技术能力确定,强调完全的解剖甚至适当的过度复位,三维、坚强内固定和早期功能锻炼.     

Proximal tibial osteophytes and their relationship with the height of the tibial spines of the intercondylar eminence: paleopathological study

Objective  

Tibial spiking (i.e., spurring of tibial spines), eburnation, and osteophytes are considered features of osteoarthritis. This investigation employed direct inspection of the medial and lateral tibial plateaus in paleopathological specimens to analyze the frequency and morphological features of osteoarthritis and to define any relationship between the size of osteophytes and that of the intercondylar tibial spines.     

关节镜下空心钉固定胫骨髁间棘骨折20例

传统的胫骨髁间棘骨折常行膝关节切开复位内固定,目前随着关节镜技术的发展,利用关节镜技术可采用不同的固定方式。笔者重点对2004年4月-2005年8月,我院收治胫骨髁间棘骨折20例,行关节镜下空心钉固定胫骨髁间棘撕脱骨折,现报道如下。     

胫骨髁间嵴骨折的治疗进展

介绍胫骨髁间嵴的解剖、损伤的病因、治疗策略及最新的治疗方法。根据国内外近年有关文献,并进行综合分析,认为胫骨髁间嵴骨折的治疗可选择非手术治疗、切开复位加内固定、关节镜下复位内固定等几种治疗方法;关节镜技术的发展为胫骨髁间嵴骨折治疗提供了新的途径。     

Type IIIB tibial intercondylar eminence fracture associated with a complex knee dislocation in a grossly obese adult

Avulsion fractures of the intercondylar eminence or tibial spine mostly occur in children and adolescents, and are extremely uncommon in adults. A type IIIB intercondylar eminence fracture (i.e. completely displaced and rotated tibial spine) associated with a complex knee dislocation is an extremely rare combination.     

交通伤后胫骨髁间棘撕脱性骨折关节镜下治疗

目的 探讨交通伤后胫骨髁间棘撕脱骨折在关节镜下复位、PDS-Ⅱ线固定的治疗方法.方法 在2005年2月～2009年12月间,我科共治疗36例交通伤后急性胫骨髁间棘撕脱骨折.男性25例,女性7例;平均年龄27.5岁(11～55岁).其中Ⅱ型9例(25%),Ⅲ型20例(56%),Ⅳ型7例(19%).手术采用关节镜下骨折复位...     

Tibial intercondylar eminence fractures in adults: arthroscopic treatment

Results obtained from the surgical treatment of 15 cases of type II and III tibial intercondylar eminence fractures—according to the classification of Meyers and McKeever [12, 13]—are reported in this paper. The average age of the patients observed was 22 years (range 18–41). All patients underwent an arthroscopic procedure of reduction and fixation. We used a bioabsorbable suture in ten patients and a nonabsorbable suture in five patients. The suture was passed at the ACL insertion, then pulled out through drilled tunnels and tied onto the anterior surface of the tibial metaphysis. Two of the 15 patients treated underwent an additional arthroscopic procedure because of arthrofibrosis, 2 months after the first surgical intervention. All patients were examined clinically and radiographically with an average follow-up of 18 months. According to the IKDC scoring system, recovery of the 13 patients not undergoing additional intervention was graded as normal or near normal. In 14 patients, anterior laxity was inferior to 5 mm at the KT-1000 arthrometer evaluation. Absorbable or nonabsorbable suture fixation is effective for obtaining a secure fixation and achieves good clinical and functional mid-term results.     

髁间棘骨折的诊断与微创治疗

目的 探讨不同影像学检查在髁间棘骨折诊断中的价值及微创治疗的疗效.方法 2004年7月-2007年12月共收治43例髁间棘骨折患者,不同影像学进行检查及微创治疗.收集术前、术后影像学资料进行对比分析及手术前后功能评分对比.结果 骨折检出率:X线片为95 %,CT三维重建为100 %,MRI为90 %.术后40例获得1～8个月随访,所有骨折均Ⅰ期愈合,膝关节功能采用美国特种外科医院(HISS)膝关节百分评分系统进行评价,优25例,良10例,中3例,差2例.结论 传统的X线为髁间棘骨折诊断中首选的经济实用的方法,CT三维重建可提高诊断率,而MRI检查则可帮助诊断交叉韧带损伤情况.关节镜下及小切口微创治疗损伤小,有利于膝关节功能的恢复,但关节镜下技术操作要求高;采取张力带的方法较其他固定方法简单可靠,不易导致骨折块碎裂,可用于任何骨折类型.     

关节镜下“8”字缝线与带线锚钉治疗胫骨髁间棘撕脱骨折的效果比较

目的比较关节镜下胫骨髁间棘撕脱骨折"8"字缝线与带线锚钉固定两种方法的疗效。方法笔者收集2007年1月~2013年9月收治的52例胫骨髁间棘骨折患者,均为Meyers-MckeeverⅡ型、Ⅲ型的患者,28例行"8"字缝线固定(A组),包括男性21例,女性7例;平均年龄24岁;24例行带线锚钉固定(B组),包括男性19例,女性5例;平均年龄22岁。比较两组伸膝功能、屈膝功能、关节稳定性及Lysholm关节功能评分。结果术后平均随访9.2个月。A组与B组伸膝功能有统计学差异(P=0.040.05),两组屈膝功能、关节稳定性及Lysholm关节功能评分无统计学差异。结论关节镜下"8"字缝线固定治疗胫骨髁间棘撕脱骨折的疗效优于带线锚钉固定。     

Insufficiency fractures of the tibial plateau

An insufficiency fracture of the tibial plateau may be the cause of knee pain in patients with osteoporosis. The diagnosis is usually not suspected until a bone scan is done, as initial radiographs are often negative or inconclusive and clinical findings are nonspecific and may simulate osteoarthritis or spontaneous. In five of 165 patients referred for bone scans due to nontraumatic knee pain, a characteristic pattern of intense augmented uptake of radionuclide confined to the tibial plateau led to a presumptive diagnosis of insufficiency fracture, later confirmed on radiographs.     

Arthroscopic fixation of the fractures of the intercondylar eminence via transquadricipital tendinous portal

We describe a new technique for arthroscopic reduction and internal fixation of fractures of the intercondylar eminence of the tibia. In this technique cannulated screws are placed through a new portal (transquadricipital tendinous) instead of anteromedial arthroscopic portal. Twelve patients who were treated with this technique for displaced types II and III fractures of the intercondylar eminence of the tibia were reviewed after a mean of 49 months. At follow-up all patients had excellent or good results, without any case of nonunion of the fracture or related complications, such as functional instability. Placement of cannulated screws through transquadricipital tendinous portal achieves fragment reduction easily, provides rigid fixation while avoiding arthrotomy, allowing early mobilization and return to activity.     

Fractures of the posterolateral tibial plateau

We reviewed the clinical records and operative notes of 28 patients with fractures of the posterolateral tibial plateau seen at our institution from 1949 to 1982. Five of the 28 patients had chronic depressions of the posterolateral tibial plateau after initial treatment elsewhere. All five were disabled because of significant functional instability when the knee was in flexion. There were 23 acute fractures, of which 4 were initially nondisplaced and treated nonoperatively. One nonoperative patient was lost to followup; the remaining three were rated as having had good or excellent results. Nineteen patients had acute depressed fractures and were treated operatively with open reduction, elevation of the depressed area, and bone grafting, with or without internal fixation. All patients treated operatively at the time of injury were seen for followup from 24 to 145 months postoperatively, with a mean followup of 59 months. One patient was lost to followup; the other 18 were rated using both objective and subjective criteria. Seventeen (94%) achieved a final rating of excellent or good; one patient (6%) achieved a rating of fair. We have observed these fractures occurring in a younger population and producing significant disability in activities requiring a stable knee in flexion. The depressed posterolateral tibial plateau fracture is best assessed by AP, lateral, and 45 degrees internal oblique views on radiographic examination. Because of continued disability caused by chronic, depressed fractures of this type, we recommend open reduction and bone grafting in acute cases to eliminate instability in flexion. This procedure produces good or excellent results in most cases.     

游离髂骨移植重建胫骨平台治疗严重胫骨平台骨折

对12例严重胫骨平台骨折采用带有内板骨膜的自体髂骨游离移植重建碎裂的胫骨平台手术治疗,优良率达75%,可有效防止创伤性膝关节炎的发生,最大程度地恢复膝关节功能。