胫骨平台后外侧髁骨折手术治疗的改良方法及临床应用

Improved method and clinical application of tibial plateau posterolateral condyle fracture surgery

目的探讨胫骨平台后外侧髁骨折治疗的难点及改良方法的临床优势。方法回顾性分析2016年3月—2018年8月无锡市惠山区人民医院收治单纯胫骨平台后外侧髁骨折24例,根据治疗方法不同分为改良组和对照组,各12例。改良组男性8例,女性4例;年龄23~66岁,平均48.5岁;对照组男性7例,女性5例;年龄21~68岁,平均47.1岁。改良组采用腓骨头上方入路联合自制环抱支撑解剖钢板进行显露复位固定,对照组采用腓骨头上方入路联合普通L形钢板进行复位固定,术后定期复查,指导膝关节功能锻炼。比较两组相关指标,包括术中出血量、手术时间、骨折愈合时间、未次随访的Rasmussen放射评分、纽约特种外科医院(Hospital for Special Surgery,HSS)功能评分以及术后膝关节功能优良率。结果术中出血量改良组(42.92±15.44)mL与对照组(51.25±14.64)mL比较差异无统计学意义(P>0.05),改良组与对照组手术时间(51.00±6.80)min vs.(63.58±7.79)min、骨折愈合时间(10.75±1.48)周vs.(12.75±1.96)周、末次随访的膝关节Rasmussen评分(17.08±2.11)分vs.(12.58±4.38)分和HSS评分(88.42±7.69)分vs.(74.83±13.27)分比较,差异有统计学意义(P<0.05)。按膝关节HSS评分评定膝关节功能,改良组优10例,良1例,可1例,优良率为91.7%;对照组优4例,良2例,可4例,差2例,优良率为50.0%,两组差异有统计学意义(P<0.05)。结论腓骨头上方入路联合自制环抱支撑解剖钢板治疗胫骨平台后外侧髁骨折,具有简单安全、手术时间短、骨折固定可靠、术后功能恢复满意等优点,是一种值得推广应用的改良方法。

Objective To explore the treatment difficulties of the tibial plateau posterolateral condyle fracture and clinical advantages of improved methods.Methods A retrospective analysis of 24 cases of tibial plateau posterolateral condyle fracture treated in the Huishan District People’s Hospital of Wuxi from Mar.2016 to Aug.2018 was carried out.They were divided into 12 cases(8 males and 4 females,aged 23-66 years with 48.5 years on average)in the modified group and 12 cases(7 males and 5 females,aged 21-68 years with 47.1 years on average)in the control group according to different treatment methods.The modified group used the superior fibular head approach combined with self-made embracing support anatomical plate for exposed reduction and fixation,and the control group used the superior fibular head approach combined with ordinary L-shaped steel plate for reduction and fixation.Regular postoperative review was performed to guide knee joint functional exercises.The related indicators such as intraoperative blood loss,operation time,fracture healing time,Rasmussen radiographic score at the last follow-up,New York Hospital for Special Surgery(HSS)functional score,and postoperative knee function excellent rate,were record and statistical analysis was applied.Results There was no significant difference in intraoperative blood loss between the modified group and the control group[(42.92±15.44)mL vs.(51.25±14.64)mL,P>0.05].The operation time,fracture healing time,and knee Rasmussen scores at the last follow-up and HSS scores were significantly better than those of the control group[(51.00±6.80)minutes vs.(63.58±7.79)minutes,(10.75±1.48)weeks vs.(12.75±1.96)weeks].There were statistical significances between the two groups(P<0.05).Knee joint function was evaluated according to the knee HSS score.In the modified group,10 cases were excellent,1 case was good,and 1 case was fair.The excellent and good rate was 91.7%.In the control group,4 cases were excellent,2 good,4 fair,and 2 poor.The excellent and good rate was 50.0%,and the difference was statistically significant(P<0.05).Conclusion The superior fibular head approach combined with self-made embracing support anatomical plate for the treatment of the tibial plateau posterolateral condyle fracture has the advantages of simplicity and safety,short operation time,reliable fracture taxation,and satisfactory postoperative functional recovery.It is an improved method worthy of popularization and application.