腓骨头上入路箍钢板治疗胫骨平台后外侧髁骨折
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摘要
[目的]介绍经腓骨头上入路水平箍钢板排筏螺钉固定治疗胫骨平台后外侧象限骨折的手术技术。[方法]回顾性分析2014年1月～2016年12月收治的9例单纯胫骨平台后外侧象限骨折患者,男6例,女3例;年龄33～67岁。根据术前X线片和CT检查,确认胫骨平台骨折均为孤立的后外侧象限骨折。术中采用侧卧位,经改良前外侧腓骨头上入路,对骨折撬拨复位,以桡骨远端钢板折弯后成水平带状并以排筏螺钉固定。[结果]手术时间52～73 min。切口均一期愈合,无切口感染发生。其中,8例随访12个月以上,无膝关节不稳、骨折再塌陷者,所有患者骨折均获愈合,愈合时间12～18周。术后12个月,HSS评分87～98分,SMFA评分14～31分,膝关节活动幅度100°～135°。患者对治疗效果非常满意者5例,满意者3例,总体满意率100%。[结论]对于孤立的胫骨平台后外侧象限骨折,经改良前外侧腓骨头上入路可以充分显露骨折端,手术操作方便;箍钢板固定骨折块稳定可靠。
[Objective] To introduce the surgical technique of a horizontal hoop plate via the supra-fibular-head approach for posterolateral tibial plateau fracture. [Methods] A retrospective study was conducted on 9 patients who underwent surgical treatment for posterolateral tibial plateau fracture from January 2014 to December 2016, including 6 males and 3 females aged33～67 years. The preoperative X-ray and CT examination revealed isolated posterolateral tibial plateau fractures in these patients. In the lateral decubitus position, the fracture was reduced and fixed with a hoop-like plate and raft-like screws prefabricated by using a T-shaped distal radius plate through the modified anterolateral supra-fibular-head approach. [Results] The patients had operations finished in 52～73 min, with primary healing obtained in all incisions and without incision infection happened in anyone of them. Among the 9 patients, 8 were followed up for more than 12 months. All the patients achieved bony healing in 12～18 weeks, with no knee instability, refracture or tibial plateau recollapse occurred in any patient. At 12 months after operation, the HSS score was of 87～98, while SMFA score of 14～31, and knee ROM of 100～135 degrees. Of them, 5 patients felt fully satisfied and the other 3 patients were satisfied to clinical outcomes with a total satisfactory rate of 100%. [Conclusion] The supra-fibular-head approach does fully expose the fracture site to facilitate the surgical operation, while the horizontal hoop plate provide stable and reliable fixation for the isolated posterolateral tibial plateau fracture,
[Objective] To introduce the surgical technique of a horizontal hoop plate via the supra-fibular-head approach for posterolateral tibial plateau fracture. [Methods] A retrospective study was conducted on 9 patients who underwent surgical treatment for posterolateral tibial plateau fracture from January 2014 to December 2016, including 6 males and 3 females aged33～67 years. The preoperative X-ray and CT examination revealed isolated posterolateral tibial plateau fractures in these patients. In the lateral decubitus position, the fracture was reduced and fixed with a hoop-like plate and raft-like screws prefabricated by using a T-shaped distal radius plate through the modified anterolateral supra-fibular-head approach. [Results] The patients had operations finished in 52～73 min, with primary healing obtained in all incisions and without incision infection happened in anyone of them. Among the 9 patients, 8 were followed up for more than 12 months. All the patients achieved bony healing in 12～18 weeks, with no knee instability, refracture or tibial plateau recollapse occurred in any patient. At 12 months after operation, the HSS score was of 87～98, while SMFA score of 14～31, and knee ROM of 100～135 degrees. Of them, 5 patients felt fully satisfied and the other 3 patients were satisfied to clinical outcomes with a total satisfactory rate of 100%. [Conclusion] The supra-fibular-head approach does fully expose the fracture site to facilitate the surgical operation, while the horizontal hoop plate provide stable and reliable fixation for the isolated posterolateral tibial plateau fracture,
引文
[1] Luo CF, Sun H, Zhang B, et al. Three-column fixation for complex tibial plateau fractures[J]. J Orthop Trauma, 2010, 24(11):683-692.
[2]胡孙君,张英琪,张世民.胫骨平台后外侧骨折的治疗进展[J].中华创伤骨科杂志, 2014, 16(10):898-901.
[3] Heidari N, Lidder S, Grechenig W, et al. The risk of injury to the anterior tibial artery in the posterolateral approach to the tibia plateau:a cadaver study[J]. J Orthop Trauma, 2013, 27(4):221-225.
[4] Garner MR, Warner SJ, Lorich DG. Surgical approaches to posterolateral tibial plateau fractures[J]. J Knee Surg, 2016, 29(1):12-20.
[5] Tao J, Hang DH, Wang QG, et al. The posterolateral shearing tibial plateau fracture:treatment and results via a modified posterolateral approach[J]. Knee, 2008, 15:473-479.
[6] Lobenhoffer P, Gerich T, Bertram T, et al. Particular posteromedial and posterolateral approaches for the treatment of tibial head fractures[J]. Unfallchirurg. 1997, 100(12):957-967.
[7] Yu B, Han K, Zhan C, et al. Fibular head osteotomy:a new approach for the treatment of lateral or posterolateral tibial plateau fractures[J]. Knee, 2010, 17(5):313-318.
[8] Carlson DA. Bicondylar fracture of the posterior aspect of the tibial plateau. A case report and a modified operative approach[J]. J Bone Joint Surg Am, 1998, 80:1049-1052.
[9] Chang SM, Zheng HP, Li HF, et al. Treatment of isolated posterior coronal fracture of the lateral tibial plateau through posterolateral approach for direct exposure and buttress plate fixation[J]. Arch Orthop Trauma Surg, 2009, 129(7):955-962.
[10] Yu GR, Xia J, Zhou JQ, et al. Low-energy fracture of posterolateral tibial plateau:treatment by a posterolateral prone approach[J].J Trauma Acute Care Surg, 2012, 72(5):1416-1423.
[11]胡孙君,张世民,张英琪,等.胫骨平台后外侧象限骨折手术入路的深层解剖:后外侧与后内侧对比[J].中国临床解剖学杂志, 2015, 33(5):497-501.
[12] He X, Ye P, Hu Y, et al. A posterior inverted L-shaped approach for the treatment of posterior bicondylar tibial plateau fractures[J]. Arch Orthop Trauma Surg, 2013, 133(1):23-28.
[13]储旭东,朱建平,蔡福金,等.胫骨平台后外侧髁骨折腓骨小头上入路设计及临床应用[J].中华骨科杂志, 2012, 32(12):1145-1150.
[14] Chen HW, Zhou SH, Liu GD, et al. An extended anterolateral approach for posterolateral tibial plateau fractures[J]. Knee Surg Sports Traumatol Arthrosc, 2015, 23(12):3750-3755.
[15] Hu SJ, Chang SM, Zhang YQ, et al. The anterolateral supra-fibular-head approach for plating posterolateral tibial plateau fractures:a novel surgical technique[J]. Injury, 2016, 47(2):502-507.
[16] Zhang W, Luo CF, Putnis S, et al. Biomechanical analysis of four different fixations for the posterolateral shearing tibial plateau fracture[J]. Knee, 2012, 19(2):94-98.
[17] Sassoon AA, Torchia ME, Cross WW, et al. Fibular shaft allograft support of posterior joint depression in tibial plateau fractures[J].J Orthop Trauma, 2014, 28(7):169-175.
[18] Giordano V, Schatzker J, Kfuri M. The"Hoop"plate for posterior bicondylar shear tibial plateau fractures:description of a new surgical technique[J]. J Knee Surg, 2017, 30(6):509-513.
[19] Cho JW, Kim J, Cho WT, et al. Approaches and fixation of the posterolateral fracture fragment in tibial plateau fractures:a review with an emphasis on rim plating via modified anterolateral approach[J]. Int Orthop, 2017,41:1887-1897.
[20] Sun H, Zhu Y, He QF, et al. Reinforcement strategy for lateral rafting plate fixation in posterolateral column fractures of the tibial plateau:the magic screw technique[J]. Injury, 2017, 48(12):2814-2826.
[21] Weimann A, Heinkele T, Herbort M, et al. Minimally invasive reconstruction of lateral tibial plateau fractures using the jail technique:a biomechanical study[J]. BMC Musculoskelet Disord,2013, 14:120.
[22]胡孙君,张世民,李双,等.水平带状钢板治疗胫骨平台后外侧象限骨折的生物力学研究[J].中国临床解剖学杂志, 2018, 36(1):77-81.
[2]胡孙君,张英琪,张世民.胫骨平台后外侧骨折的治疗进展[J].中华创伤骨科杂志, 2014, 16(10):898-901.
[3] Heidari N, Lidder S, Grechenig W, et al. The risk of injury to the anterior tibial artery in the posterolateral approach to the tibia plateau:a cadaver study[J]. J Orthop Trauma, 2013, 27(4):221-225.
[4] Garner MR, Warner SJ, Lorich DG. Surgical approaches to posterolateral tibial plateau fractures[J]. J Knee Surg, 2016, 29(1):12-20.
[5] Tao J, Hang DH, Wang QG, et al. The posterolateral shearing tibial plateau fracture:treatment and results via a modified posterolateral approach[J]. Knee, 2008, 15:473-479.
[6] Lobenhoffer P, Gerich T, Bertram T, et al. Particular posteromedial and posterolateral approaches for the treatment of tibial head fractures[J]. Unfallchirurg. 1997, 100(12):957-967.
[7] Yu B, Han K, Zhan C, et al. Fibular head osteotomy:a new approach for the treatment of lateral or posterolateral tibial plateau fractures[J]. Knee, 2010, 17(5):313-318.
[8] Carlson DA. Bicondylar fracture of the posterior aspect of the tibial plateau. A case report and a modified operative approach[J]. J Bone Joint Surg Am, 1998, 80:1049-1052.
[9] Chang SM, Zheng HP, Li HF, et al. Treatment of isolated posterior coronal fracture of the lateral tibial plateau through posterolateral approach for direct exposure and buttress plate fixation[J]. Arch Orthop Trauma Surg, 2009, 129(7):955-962.
[10] Yu GR, Xia J, Zhou JQ, et al. Low-energy fracture of posterolateral tibial plateau:treatment by a posterolateral prone approach[J].J Trauma Acute Care Surg, 2012, 72(5):1416-1423.
[11]胡孙君,张世民,张英琪,等.胫骨平台后外侧象限骨折手术入路的深层解剖:后外侧与后内侧对比[J].中国临床解剖学杂志, 2015, 33(5):497-501.
[12] He X, Ye P, Hu Y, et al. A posterior inverted L-shaped approach for the treatment of posterior bicondylar tibial plateau fractures[J]. Arch Orthop Trauma Surg, 2013, 133(1):23-28.
[13]储旭东,朱建平,蔡福金,等.胫骨平台后外侧髁骨折腓骨小头上入路设计及临床应用[J].中华骨科杂志, 2012, 32(12):1145-1150.
[14] Chen HW, Zhou SH, Liu GD, et al. An extended anterolateral approach for posterolateral tibial plateau fractures[J]. Knee Surg Sports Traumatol Arthrosc, 2015, 23(12):3750-3755.
[15] Hu SJ, Chang SM, Zhang YQ, et al. The anterolateral supra-fibular-head approach for plating posterolateral tibial plateau fractures:a novel surgical technique[J]. Injury, 2016, 47(2):502-507.
[16] Zhang W, Luo CF, Putnis S, et al. Biomechanical analysis of four different fixations for the posterolateral shearing tibial plateau fracture[J]. Knee, 2012, 19(2):94-98.
[17] Sassoon AA, Torchia ME, Cross WW, et al. Fibular shaft allograft support of posterior joint depression in tibial plateau fractures[J].J Orthop Trauma, 2014, 28(7):169-175.
[18] Giordano V, Schatzker J, Kfuri M. The"Hoop"plate for posterior bicondylar shear tibial plateau fractures:description of a new surgical technique[J]. J Knee Surg, 2017, 30(6):509-513.
[19] Cho JW, Kim J, Cho WT, et al. Approaches and fixation of the posterolateral fracture fragment in tibial plateau fractures:a review with an emphasis on rim plating via modified anterolateral approach[J]. Int Orthop, 2017,41:1887-1897.
[20] Sun H, Zhu Y, He QF, et al. Reinforcement strategy for lateral rafting plate fixation in posterolateral column fractures of the tibial plateau:the magic screw technique[J]. Injury, 2017, 48(12):2814-2826.
[21] Weimann A, Heinkele T, Herbort M, et al. Minimally invasive reconstruction of lateral tibial plateau fractures using the jail technique:a biomechanical study[J]. BMC Musculoskelet Disord,2013, 14:120.
[22]胡孙君,张世民,李双,等.水平带状钢板治疗胫骨平台后外侧象限骨折的生物力学研究[J].中国临床解剖学杂志, 2018, 36(1):77-81.