选择性胫骨外髁U形截骨入路治疗胫骨外侧平台塌陷粉碎骨折

目的:探讨选择性胫骨外髁"U "形截骨入路治疗胫骨外侧平台塌陷粉碎骨折的方法和临床疗效。方法:自2014年1月至2019年10月,采用选择性胫骨外髁" U"形截骨入路对15例胫骨外侧平台塌陷粉碎骨折患者进行手术治疗,其中男9例,女6例;年龄25~70(38.5±7.7)岁。按照胫骨平台外侧髁骨折ABC分型,A型2例,B型6例,BC型4例,C型3例;合并内侧平台骨折5例;左膝8例,右膝7例。伤后至就诊时间1~14(3.4±1.2) d。所有患者CT提示胫骨外侧平台塌陷>2 mm,粉碎骨块>2块,胫骨外侧髁皮质完整。术后12个月采用Rasmussen骨折复位解剖学评分评价骨折复位情况,并采用Rasmussen功能评分评价膝关节功能。结果:15例患者选择性"U "形截骨一次成功,手术时间55~110(85.6±20.0) min,外侧平台手术时间20~60(30.5±10.5) min。所有患者获随访,时间12~24(14.6±2.5)个月。骨折愈合时间12~24(13.6±3.6)周。术后12个月膝关节Rasmussen骨折复位解剖学评分14~18(17.5±0.3)分,其中优13例,良2例。膝关节Rasmussen功能评分13~30(26.8±2.5)分;其中优12例,良1例,可2例。2例外侧平台高度分别丢失2 mm和4 mm,1例膝关节5°外翻畸形,1例关节僵硬(10°~100°)。未发生腓总神经损伤、腘血管损伤,术后无感染、内固定失效等严重并发症。结论:采用选择性胫骨外髁" U"形截骨入路治疗胫骨外侧平台塌陷粉碎性骨折,具有手术切口简单、骨折显露直接、复位固定准确、手术时间短,并发症少等优点,是一种有效、可靠的方法。

Selective U-shaped osteotomy of lateral tibial condyle for the treatment of collapse and comminuted fracture of lateral tibial plateau

Objective: To explore methods and clinical effects of selective U-shaped osteotomy of lateral tibial condyle in treating collapse and comminuted fracture of lateral tibial plateau.Methods: From January 2014 to October 2019,15 patients with collapse and comminuted fracture of lateral tibial plateau were treated by selective U-shaped osteotomy of lateral tibial condyle,including 9 males and 6 females. The age of patients ranged from 25 to 70 years old,with an average age of (38.5±7.7) years old. According to ABC classification of condyle fracture of tibial plateau lateral,there were 2 cases of type A,6 cases of type B,4 cases of type BC and 3 cases of type C. Five patients were combined with medial plateau fracture,8 patients were combined with left knee fracture and 7 patients of right knee fracture. The time of treatment after injury ranged from 1 day to 14 days with an average of (3.4±1.2) days. CT of all patients showed that lateral tibial plateau collapsed more than 2 mm,more than 2 pieces of bones were crushed and broken,and lateral tibial condyle cortex was intact. At follow-up of 12 months after operation,Rasmussen''s anatomical grading system was used to evaluate fracture reduction. Rasmussen''s functional grading system were used to evaluate knee joint function.Results: Selective U-shaped osteotomy was successfully complated in 15 patients at one time,and operation time ranged from 55 to 110 min,with an average time of (85.6±20.0) min. The lateral plateau operation ranged from 20 to 60 min with an average time of(30.5±10.5) min. All patients were followed up for 12 to 24 months with an average of (14.6±2.5) months. Fracture healing time was 12 to 24 weeks,with an average of (13.6±3.6) weeks. At follow-up 12 months after operation,by Rasmussen''s grading system,anatomical score of knee joint ranged from 14 to 18 points,with an average score of (17.5±0.3) points,of which 13 cases were excellent and 2 cases were good. The functional score ranged from 13 points to 30 points,with an average score of (26.8±2.5) points. Among them,12 cases were excellent,1 case was good,2 cases were fair. Two patients suffered 2 mm and 4 mm loss of lateral tibial plateau,1 case of knee joint 5 ° valgus,1 case of stiff joints (10 ° to 100 °). No common peroneal nerve injury,important vascular injury,postoperative infection,internal fixation failure and other serious complications was found.Conclusion: The use of selective lateral tibial condyle "U"- shaped osteotomy approach is an effective and reliable method to treat the collapse and comminuted fracture of the lateral tibial plateau. It has the advantages of simple surgical incision,direct fracture exposure,accurate repositioning and fixation,short operation time and few complications.