后方入路治疗胫骨平台后髁冠状位骨折的疗效分析

EFFECTIVENESS OF POSTERIOR APPROACHES FOR TREATMENT OF POSTERIOR CORONAL FRACTURE OF TIBIAL PLATEAU

目的探讨后方入路治疗胫骨平台后髁冠状位骨折的临床疗效,分析该类骨折形态、手术入路的选择以及对Schatzker分型的再认识。方法回顾分析2003年6月-2009年6月23例采用后方入路治疗胫骨平台后髁冠状位骨折患者的临床资料。男15例,女8例;年龄32～56岁,平均38岁。均为闭合性骨折。致伤原因:高处坠落伤5例,交通事故伤15例,运动损伤3例。骨折按Moore分型:Ⅰ型10例,Ⅱ型9例,Ⅳ型4例。常规行膝关节正侧位X线片、CT扫描及三维重建。患者受伤至手术时间为3～14d,平均6d。结果骨折获解剖复位17例,一般复位6例。术后切口均Ⅰ期愈合。23例均获随访,随访时间12～36个月,平均24个月。骨折于术后6～9个月达临床愈合,平均7.6个月。无神经、血管损伤、内固定失效、关节僵硬、创伤性骨关节炎、畸形愈合等并发症发生。末次随访时根据Rasmussen评分系统评定膝关节功能,获优14例,良7例,可2例,优良率为91.3%。结论胫骨平台后髁冠状位骨折少见,有其独特的形态特点,Schatzker分型不能完全涵盖该类骨折。采用后方入路可在直视下复位关节面,固定牢靠,术后可早期行功能锻炼,并发症少,是较好的手术治疗方案。

Objective To observe the effectiveness of posterior approaches for the treatment of posterior coronal fractures of tibial plateau,and to analyze the fracture morphology,radiographic features,and the recognition of Schatzker classification.Methods Between June 2003 and June 2009,23 patients with posterior coronal fractures of tibial plateau were treated surgically by posterior approaches.There were 15 males and 8 females with an average age of 38 years（range,32-56 years）.All patients had closed fractures.Fracture was caused by traffic accident in 15 cases,by sports in 3 cases,and by falling from height in 5 cases.According to Moore classification,there were 10 cases of type I,9 cases of type II,and 4 cases of type IV.The X-ray films,CT scanning,and three-dimensional reconstruction were performed.The time from injury to operation was 3-14 days（mean,6 days）.Results After operation,17 cases had anatomical reduction and 6 had normal reduction.Incisions healed by first intention.All cases were followed up 12 to 36 months（mean,24 months）.The average fracture healing time was 7.6 months（range,6-9 months）.No related complication occurred,such as nerve and vessel injuries,failure in internal fixation,ankylosis,traumatic osteoarthritis,and malunion.According to Rasmussen’s criteria for the function of the knee,the results were excellent in 14 cases,good in 7 cases,and fair in 2 cases with an excellent and good rate of 91.3%.Conclusion Posterior coronal fracture of tibial plateau is rare,which has distinctive morphological features,and Schatzker classification can not contain it totally.The advantages of posterior approach include reduction of articular surface under visualization,firm fixation,less complications,and earlier functional exercise,so it is an ideal surgical treatment plan