复杂SchatzkerⅣ型胫骨平台骨折的治疗分析

Treatment analysis of complex Schatzker typeⅣtibial plateau fractures

目的:探讨复杂SchatzkerⅣ型胫骨平台骨折的治疗策略。方法:自2016年1月至2021年1月收治41例复杂SchatzkerⅣ型胫骨平台骨折患者,男28例,女13例,年龄19~65(35.3±19.8)岁。根据术前影像学特征制定个体化治疗方案,以后内侧手术入路为主结合其他辅助切口;采用后内侧倒“L”入路18例,后内侧入路+前外侧扩展入路19例,后内侧入路+前外侧入路+外侧髁截骨4例。观察关节面和骨折愈合情况,术后12个月测量膝关节活动度,并采用Lysholm评分系统评价膝关节功能。结果:41例患者均获得随访,时间12~26(13.3±6.8)个月。29例和10例患者分别在术后6、12个月获得完全骨折愈合,骨折愈合时间4~13(5.0±3.7)个月;2例患者出现后内侧内固定失效、膝关节内翻畸形,经二次手术后骨折愈合、内翻畸形纠正。术后12个月膝关节活动度(118±29)°,Lysholm评分(83.0±16.0)分。结论:复杂SchatzkerⅣ型胫骨平台骨折应合理选择个体化治疗方式,外侧平台骨折特点是选择手术入路的重要参考,应充分重视后内侧骨块的有效固定,治疗结果总体满意。

Objective To explore treatment strategy for complex SchatzkerⅣtibial plateau fracture.Methods Forty-one patients with complex Schatzker typeⅣtibial plateau fractures were treated from January 2016 to January 2021,including 28 males and 13 females,aged from 19 to 65 years old with an average of(35.3±19.8)years old.Individualized treatment plan was developed according to preoperative imaging characteristics,medial surgical approach was mainly combined with other auxiliary incisions.Posteromedial inverted L approach was used in 18 patients,posteromedial approach and anterolateral extended approach in 19 patients,and posteromedial approach with anterolateral and lateral condylar osteotomy in 4 patients.Articular surface and facture healing were observed,range of knee joint motion was measured at 12 months after opertaion,and function of knee joint was evaluated by Lysholm scoring system.Results Forty-one patients were followed up for 12 to 26 months with an average of(13.3±6.8)months.Twenty-nine patients and 10 patients were obtained complete fracture healing at 6 and 12 months after operation respectively,and fracture healing time was 4 to 13 months with an average of(5.0±3.7)months.Two patients occurred posterior medial internal fixation failure and varus deformity of knee joint,and the fracture healed and varus deformity was corrected after the second operation.Range of knee joint motion was(118±29)°,and Lysholm score was(83.0±16.0)points.Conclusion Individualized treatment should be reasonably selected for complex SchatzkerⅣtibial plateau fractures,the characteristics of lateral plateau fractures are an important reference for selecting surgical approaches,the effective fixation of posteromedial bone blocks should be pay full attention,and the overall treatment results are satisfied.