腓骨近端骨折对胫骨平台后外侧髁骨折手术预后的影响

Effect of Proximal Fibular Fracture on Surgical Prognosis of Posterolateral Condylar Fracture of Tibial Plateau

目的探讨腓骨近端骨折对累及后外侧髁的复杂胫骨平台骨折手术预后的影响。方法回顾性分析自2014年1月至2019年12月,我院收治的累及后外侧髁的胫骨平台SchatzkerⅣ、Ⅴ、Ⅵ型骨折接受手术治疗的患者118例,其中男60例,女58例;年龄18~75岁,平均年龄(51.8±10.6)岁。按有无腓骨近端骨折和后外侧支撑钢板固定分为A1、A2和B1、B2组,A1组无腓骨近端骨折但有后外侧支撑钢板固定,共30例;A2组无腓骨近端骨折也无后外侧支撑钢板固定,共32例;B1组有腓骨近端骨折又有后外侧支撑钢板固定,共28例;B2组有腓骨近端骨折但无后外侧支撑钢板固定,共28例。对A1、A2和B1、B2组间患者的手术时间、术中出血量、胫骨平台内翻角(tibial plateau angle,TPA)、胫骨平台后倾角(posterior slope angle,PA)及美国特种外科医院(hospital for special surgery,HSS)膝关节评分优良率进行比较。结果118例患者均获随访,随访时间12~16个月,平均(13.2±1.5)个月。末次随访时,A1组与A2组的TPA、PA及HSS膝关节评分优良率比较,差异均无统计学意义(P>0.05);B1组与B2组的手术时间、出血量及末次随访TPA、PA、HSS膝关节评分优良率比较,差异均有统计学意义(P<0.05)。118例均无感染、内固定松动或断裂及腓总神经损伤。结论合并腓骨近端骨折累及后外侧髁的胫骨平台SchatzkerⅣ、Ⅴ、Ⅵ型骨折患者,手术中进行后外侧支撑钢板固定能更有效地减少继发性复位丢失,获得更好的预后。

Objective To investigate the effect of proximal fibula fracture on the surgical prognosis of complex tibial plateau fracture involving posterior lateral condyle.Methods A retrospective analysis was performed on 118 patients with Schatzker typeⅣ,ⅤandⅥfractures of tibial plateau involving the posterolateral condyle treated in our hospital from January 2014 to December 2019,including 60 males and 58 females.The age ranged from 18 to 75 years,with an average age of(51.8±10.6)years.Group A1,A2,B1 and B2 were divided according to whether proximal fibular fracture and posterolateral bracing plate fixation were present.Group A1 had no proximal fibular fracture but posterolateral bracing plate fixation,with a total of 30 cases.There were 32 cases in group A2 without proximal fibula fracture or posterolateral support plate fixation.Group B1 had proximal fibula fracture and posterolateral bracing plate fixation,with a total of 28 cases.There were 28 patients in group B2 with proximal fibula fracture without posterolateral plate fixation.The operation time,intraoperative bleeding,tibial plateau angle(TPA),posterior slope angle(PA)and the excellent and good rate of knee score in hospital for special surgery(HSS)were compared among A1,A2 and B1,B2 groups.Results All 118 patients were followed up for 12 to 16 months,with an average of(13.2±1.5)months.At the last follow-up,there were no significant differences in the excellent and good rates of TPA,PA and HSS knee score between group A1 and group A2(P>0.05).There were statistically significant differences between group B1 and group B2 in operation time,blood loss and the excellent and good rate of TPA,PA and HSS knee score in the last follow-up(P<0.05).118 cases had no infection,loosening or or broken of internal fixation and peroneal nerve injury.Conclusion In patients with SchatzkerⅣ,ⅤandⅥfractures of the tibial plateau complicated with proximal fibular fractures and involving the posterolateral condyle,posterolateral support plate fixation can more effectively reduce the loss of secondary reduction and obtain a better prognosis.