后外侧关节面塌陷胫骨平台骨折手术方法和效果探讨

CLINICAL EFFECT OF SURGERY IN TREATMENT OF TIBIAL PLATEAU FRACTURE WITH POSTEROLATERAL ARTICULAR SURFACE DEPRESSION

目的 探讨后外侧关节面塌陷胫骨平台骨折手术方法和效果。方法 回顾性分析2018年6月—2020年8月郑州市骨科医院治疗的19例后外侧关节面塌陷的胫骨平台骨折病人的临床资料。均采用前外侧入路外侧平台截骨联合边缘钢板(rim plate)技术治疗。末次随访通过患膝关节正侧位X线平片评估骨折愈合及复位情况,采用美国特种外科医院(HSS)评分评估患膝关节功能。结果 所有病人均顺利完成手术,手术切口长度为(10.9±0.7)cm;手术时间(78.0±17.7)min;术中出血量(258.7±38.9)mL;随访时间(13.6±1.3)月;骨折愈合时间(4.8±0.6)月;末次随访时优良率94.74%;均无血管和神经损伤等并发症发生。结论 前外侧入路外侧平台截骨联合rim plate技术治疗可有效恢复关节面的平整度,骨折愈合好,有利于膝关节功能恢复,且安全性高。

Objective To investigate the clinical effect of surgery in the treatment of tibial plateau fracture with posterolateral articular surface depression. Methods A retrospective analysis was performed for the clinical data of 19 patients with ti-bial plateau fracture involving posterolateral articular surface depression who underwent surgery in Zhengzhou Orthopedic Hospital from June 2018 to August 2020. All patients underwent lateral osteotomy via the anterolateral approach combined with the rim plate technique. At last follow-up, anteroposterior and lateral X-ray films of the affected knee joint were used to evaluate fracture healing and anatomical reduction, and Hospital for Special Surgery(HSS) score was used to assess the function of the affected knee joint. Results All patients underwent the surgery successfully, with a mean incision length of(10.9±0.7) cm, a mean time of operation of(78.0±17.7) min, and a mean intraoperative blood loss of(258.7±38.9) mL. The mean follow-up time was(13.6±1.3) months, and the mean time to fracture healing was(4.8±0.6) months. The excellent and good rate was 94.74% at last follow-up. No complications such as vascular or nerve damage were observed. Conclusion Lateral osteotomy via the anterolateral approach combined with the rim plate technique is safe and effective in the treatment of tibial plateau fracture with posterolateral articular surface depression. It can effectively restore the flatness of the joint surface and help to achieve good fracture healing and rapid recovery of knee joint function.