Schatzker Ⅱ型深度塌陷胫骨平台骨折的形态特点与治疗策略

Morphological characteristics and treatment strategy of Schatzker type Ⅱ deep collapse fractures of tibial plateau

目的研究Schatzker Ⅱ型深度塌陷胫骨平台骨折的形态特点、治疗策略和临床疗效。方法回顾性分析自2016-01—2020-12采用切开复位内固定手术治疗的45例Schatzker Ⅱ型深度塌陷胫骨平台骨折,分析此类骨折的形态特点,观察术后临床疗效并总结治疗策略。术后即刻、术后12个月测量胫骨平台内翻角和胫骨平台后倾角评估骨折复位丢失情况,采用Rasmussen放射学评分评估胫骨平台骨折复位情况。末次随访时采用改良HSS评分评估膝关节功能。结果45例均获得随访,随访时间12~22个月,平均16.5个月。随访期间未出现内固定物松动、断裂,未出现关节面高度丢失。骨折均获得骨性愈合,骨折愈合时间为11~18周,平均13.8周。术后12个月骨折复位Rasmussen放射学评分14~18分,平均16.5分;优36例,良9例。术后12个月改良膝关节功能HSS评分为80~98分,平均92.2分;优33例,良12例。术后即刻胫骨平台内翻角为85.2°~89.2°,平均87.2°;胫骨平台后倾角为5.6°~8.9°,平均7.1°。术后12个月胫骨平台内翻角为85.0°~89.2°,平均87.1°;胫骨平台后倾角为5.4°~9.0°,平均7.1°。结论SchatzkerⅡ型深度塌陷胫骨平台骨折大多累及外侧柱和后柱,需采用前外侧入路或后外侧入路复位固定骨折,并进行自体髂骨结构性植骨,恢复关节面的平整及下肢力线,同时修复半月板及韧带损伤,重建膝关节的稳定性。

Objective To research the morphological characteristics,treatment strategy and clinical effect of Schatzker type Ⅱ deep collapse tibial plateau fractures.Methods A retrospective analysis was conducted on 45 cases of Schatzker type Ⅱ deep collapse tibial plateau fractures treated with open reduction and internal fixation surgery from January 2016 to December 2020.The morphological characteristics of these fractures were collected,and the postoperative clinical efficacy and treatment strate-gies were evaluated.The tibial plateau angle and posterior slope angle of the tibial plateau immediately after surgery and 12 months after surgery were measured to evaluate the loss of fracture reduction.The Rasmussen radiological score was used to evaluate the fracture reduction of tibial plateau.At the last follow-up,the improved HSS score was used to evaluate knee joint function.Results All cases were followed up for 12-22 months,with an average of 16.5 months.During the follow-up period,there was no looseness or breakage of the internal fixation,and no loss of joint surface height.All fractures achieved bone healing in 11-18 weeks,with an average of 13.8 weeks.Twelve months after surgery,the Rasmussen radiological score for tibial plateau fracture reduction was 14-18 points,with an average of 16.5 points.Of the 45 cases,36 cases were excellent and 9 cases were good.The improved HSS score for knee joint function 12 months after operation was 80-98 points,with an average score of 92.2 points,while 33 cases were excellent and 12 cases were good.The tibial plateau angle of tibial plateau immediately after surgery was 85.2°-89.2°,with an average of 87.2°;the posterior slope angle of the tibial plateau was 5.6°-8.9°,with an average of 7.1°.The tibial plateau angle of tibial plateau 12 months after surgery was 85.0°-89.2°,with an average of 87.1°;the posterior slope angle of the tibial plateau was 5.4°-9.0°,with an average of 7.1°.Conclusion Most of Schatzker type Ⅱ deep collapse tibial plateau fractures involve the lateral and posterior columns,which require reduction and fixation of the fractures through anterior lateral or posterior lateral approaches and autologous iliac bone structural grafting to restore joint flatness and lower limb alignment.At the same time,meniscus and ligament injuries should be repaired to reconstruct knee joint stability.