目的:探讨改良Frosch入路在累及后外侧柱的SchatzkerⅡ型胫骨平台骨折中的临床疗效。方法:自2019年1月至2020年9月,共收治累及后外侧柱的SchatzkerⅡ型胫骨平台骨折患者11例,男7例,女4例,年龄21~49岁,采用侧卧位改良Frosch入路,后外侧...目的:探讨改良Frosch入路在累及后外侧柱的SchatzkerⅡ型胫骨平台骨折中的临床疗效。方法:自2019年1月至2020年9月,共收治累及后外侧柱的SchatzkerⅡ型胫骨平台骨折患者11例,男7例,女4例,年龄21~49岁,采用侧卧位改良Frosch入路,后外侧骨折块采用支撑钢板或由后向前螺钉固定,前外侧采用常规胫骨平台外侧锁定钢板固定。X线测量术后即刻及术后12个月时胫骨平台内翻角和后倾角,及术后12个月膝关节活动度,采用美国特种外科医院(Hospital for Specdial Surgery,HSS)膝关节评分评价术后12个月时膝关节功能恢复情况。结果:11例患者获得随访,时间12~15个月。术后即刻内翻角、后倾角分别为76°~86°、6°~10°,术后12个月分别为79°~88°、6°~10°。术后12个月膝关节活动度,伸0°~5°,屈曲106°~137°。术后12个月HSS膝关节评分为74~94分,优8例,良3例。结论:经改良Frosch入路在累及后外侧柱的SchatzkerⅡ型胫骨平台骨折是一种有效的手术方法,单一切口完成2个部位骨折显露固定,避免采用联合切口,可获得良好的术后膝关节功能。术中应熟悉掌握腘窝结构,注意保护腓总神经,避免损伤。展开更多
Schatzkter type-I tibial plateau fracture is a split fracture of the lateral tibial plateau in sagittal plane,consequent to valgus impaction caused by low velocity of trauma.However,a deep understanding of the differe...Schatzkter type-I tibial plateau fracture is a split fracture of the lateral tibial plateau in sagittal plane,consequent to valgus impaction caused by low velocity of trauma.However,a deep understanding of the different columns of the tibial plateau and patho-mechanisms of the injury led to the unmasking of atypical fractures around the tibial plateau.We have encountered 2 cases with unusual fracture pattern of the lateral tibial condyle caused by road traffic accidents.The fracture pattern and severity of injury deviate from the original description of Schatzker type 1;in view of dual plane split,there is rotation of the posterolateral column fragment along its sagittal plane plus grade-III medial collateral ligament injury.The patients were initially treated with knee spanning external fixator and after a latency of 5 days,definitive fracture specific fixation was done,combined with repair of grade-III medial collateral ligament injury.At the 6 months follow-up both the patients achieved satisfactory knee functions(knee society score case 1:100 and case 2:92)and returned to their jobs.The severity of fracture pattern and displacement as described should prompt for examination of associated ligament injury.Because of timely diagnosis,early and appropriate care promised an excellent function outcome even in such a severe nature of knee injury.To prompt the description of injury pattern we coined the name"dual split and dislocation"of lateral tibial plateau,as a complex injury variant of split fracture of lateral tibial plateau fracture.展开更多
目的探索不同轴向载荷下3种固定方式(外侧钢板螺钉组、后侧钢板螺钉组、前后拉力螺钉组)治疗胫骨平台后外侧骨折的生物力学特性差异。方法利用胫骨平台CT图片的相关数据建立胫骨平台后外侧1/2和1/4骨折3种固定方式的实体模型,进行网格...目的探索不同轴向载荷下3种固定方式(外侧钢板螺钉组、后侧钢板螺钉组、前后拉力螺钉组)治疗胫骨平台后外侧骨折的生物力学特性差异。方法利用胫骨平台CT图片的相关数据建立胫骨平台后外侧1/2和1/4骨折3种固定方式的实体模型,进行网格划分。分析不同轴向载荷作用下,3种固定方式治疗胫骨平台后外侧1/2和1/4骨折模型的受力状况。结果 1 k N轴向载荷下,对于1/2骨折固定模型,外侧钢板螺钉组、后侧钢板螺钉组、前后拉力螺钉组骨折块的位移分别为552.082、67.964、54.085μm,内固定物的应力分别为306.745、231.844、73.047 MPa;对于1/4骨折固定模型,外侧钢板螺钉组、后侧钢板螺钉组、前后拉力螺钉组骨折块的位移分别为416.072、302.107、150.639μm,内固定的应力分别为306.673、208.467、73.607 MPa。1.5 k N轴向载荷下,各种固定方式下骨折块的位移和内固定物的应力都相应增加,数据的变化趋势同1 k N载荷情况相似。结论两种载荷下,不同骨折模型均显示前后拉力螺钉组的生物力学稳定性最具优势,后侧钢板螺钉亦可以获得相近的力学特性。在临床工作中,对于移位不明显的胫骨平台后外侧骨折,前后拉力螺钉固定方式可以作为首选。展开更多
文摘目的:探讨改良Frosch入路在累及后外侧柱的SchatzkerⅡ型胫骨平台骨折中的临床疗效。方法:自2019年1月至2020年9月,共收治累及后外侧柱的SchatzkerⅡ型胫骨平台骨折患者11例,男7例,女4例,年龄21~49岁,采用侧卧位改良Frosch入路,后外侧骨折块采用支撑钢板或由后向前螺钉固定,前外侧采用常规胫骨平台外侧锁定钢板固定。X线测量术后即刻及术后12个月时胫骨平台内翻角和后倾角,及术后12个月膝关节活动度,采用美国特种外科医院(Hospital for Specdial Surgery,HSS)膝关节评分评价术后12个月时膝关节功能恢复情况。结果:11例患者获得随访,时间12~15个月。术后即刻内翻角、后倾角分别为76°~86°、6°~10°,术后12个月分别为79°~88°、6°~10°。术后12个月膝关节活动度,伸0°~5°,屈曲106°~137°。术后12个月HSS膝关节评分为74~94分,优8例,良3例。结论:经改良Frosch入路在累及后外侧柱的SchatzkerⅡ型胫骨平台骨折是一种有效的手术方法,单一切口完成2个部位骨折显露固定,避免采用联合切口,可获得良好的术后膝关节功能。术中应熟悉掌握腘窝结构,注意保护腓总神经,避免损伤。
文摘Schatzkter type-I tibial plateau fracture is a split fracture of the lateral tibial plateau in sagittal plane,consequent to valgus impaction caused by low velocity of trauma.However,a deep understanding of the different columns of the tibial plateau and patho-mechanisms of the injury led to the unmasking of atypical fractures around the tibial plateau.We have encountered 2 cases with unusual fracture pattern of the lateral tibial condyle caused by road traffic accidents.The fracture pattern and severity of injury deviate from the original description of Schatzker type 1;in view of dual plane split,there is rotation of the posterolateral column fragment along its sagittal plane plus grade-III medial collateral ligament injury.The patients were initially treated with knee spanning external fixator and after a latency of 5 days,definitive fracture specific fixation was done,combined with repair of grade-III medial collateral ligament injury.At the 6 months follow-up both the patients achieved satisfactory knee functions(knee society score case 1:100 and case 2:92)and returned to their jobs.The severity of fracture pattern and displacement as described should prompt for examination of associated ligament injury.Because of timely diagnosis,early and appropriate care promised an excellent function outcome even in such a severe nature of knee injury.To prompt the description of injury pattern we coined the name"dual split and dislocation"of lateral tibial plateau,as a complex injury variant of split fracture of lateral tibial plateau fracture.
文摘目的探索不同轴向载荷下3种固定方式(外侧钢板螺钉组、后侧钢板螺钉组、前后拉力螺钉组)治疗胫骨平台后外侧骨折的生物力学特性差异。方法利用胫骨平台CT图片的相关数据建立胫骨平台后外侧1/2和1/4骨折3种固定方式的实体模型,进行网格划分。分析不同轴向载荷作用下,3种固定方式治疗胫骨平台后外侧1/2和1/4骨折模型的受力状况。结果 1 k N轴向载荷下,对于1/2骨折固定模型,外侧钢板螺钉组、后侧钢板螺钉组、前后拉力螺钉组骨折块的位移分别为552.082、67.964、54.085μm,内固定物的应力分别为306.745、231.844、73.047 MPa;对于1/4骨折固定模型,外侧钢板螺钉组、后侧钢板螺钉组、前后拉力螺钉组骨折块的位移分别为416.072、302.107、150.639μm,内固定的应力分别为306.673、208.467、73.607 MPa。1.5 k N轴向载荷下,各种固定方式下骨折块的位移和内固定物的应力都相应增加,数据的变化趋势同1 k N载荷情况相似。结论两种载荷下,不同骨折模型均显示前后拉力螺钉组的生物力学稳定性最具优势,后侧钢板螺钉亦可以获得相近的力学特性。在临床工作中,对于移位不明显的胫骨平台后外侧骨折,前后拉力螺钉固定方式可以作为首选。
