过伸型胫骨平台骨折研究进展

Research progress on hyperextension tibial plateau fractures

目的总结过伸型胫骨平台骨折的临床研究进展。方法查阅近年国内外相关文献,从过伸型胫骨平台骨折的损伤机制、临床类型、治疗特点等方面进行总结分析。结果过伸型胫骨平台骨折属于过伸型膝关节损伤的一种,是膝关节在过伸位(<0°)遭受暴力导致的特殊骨折类型。过伸型胫骨平台骨折可分为4种类型,即胫骨平台边缘撕脱骨折、前内侧平台压缩骨折、前外侧平台压缩骨折和双髁骨折。损伤结构遵从对角线机制,即前侧压缩、后侧牵张。胫骨平台前侧的骨折范围越小,则伴发后侧韧带损伤的可能性就越大。过伸型胫骨平台单髁骨折以前内侧面压缩(边缘小片骨折或大块骨折)和后外侧角牵张破裂为特征,治疗上需同时兼顾骨折和韧带损伤。过伸型胫骨平台双髁骨折以后侧干骺端皮质的张力性破裂及胫骨平台关节面的反屈和压缩为特征,恢复正常的后倾角是手术治疗关键。结论过伸型胫骨平台骨折尚无统一公认的治疗模式,需要进一步加强基础和临床研究。

Objective To summarize the progress in the treatment of hyperextension tibial plateau fractures. Methods Related literature concerning hyperextension tibial plateau fractures was reviewed and analyzed in terms of injury mechanisms, clinical patterns, and treatment outcomes. Results Hyperextension tibial plateau fractures is a specific type of hyperextension knee injuries, which is happened with the knee in over-extended position （〈0~） and characterized by fracture and concomitant ligament injury. It can be classified into 4 patterns： marginal avulsion fractures, unicondylar anteromedial fractures, anterolateral fractures, and bicondylar fractures. The failure of structures occurs according to the diagonal injury mechanism characterized by anterior compression fractures and posterior tension ruptures. It is noted as a rule that a smaller anterior fragment is more likely to accompany by a posterior ligament rupture. Unicondylar anteromedial fracture pattern is caused by hyperextension varus mechanism and usually accompanied by posterolateral corner rupture. Bicondylar hyperextension injury is characterized by posterior metaphyseal cortical tension rupture, a^terior articular depression, and reversed posterior slope. Conclusion Currently there is no consensus on the treatment of hyperextension tibial plateau fractures. Further basic and clinical studies are needed.