保留髂胫束止点Gerdy结节截骨外侧入路治疗单纯后外侧胫骨平台骨折
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摘要
目的探讨保留髂胫束止点Gerdy结节截骨外侧入路治疗单纯后外侧胫骨平台骨折的临床疗效。方法采用保留髂胫束止点Gerdy结节截骨外侧入路治疗16例单纯后外侧胫骨平台骨折患者。摄X线片评估骨折愈合情况,随访观察膝关节活动度(ROM)、关节面塌陷程度及内固定物松动或断裂情况。采用HSS评分评价膝关节功能。结果患者均获得随访,时间15～20个月。患者手术切口均一期愈合,无切口感染、重要血管神经损伤、后侧骨块再次移位、内固定物松动或断裂等并发症。术后3个月X线片显示骨折线均模糊,术后12个月骨折线均消失。末次随访时,膝ROM伸-3°～5°、屈100°～145°;胫骨平台关节面塌陷程度0～4(2. 0±0. 5) mm; HSS膝关节功能评分90～96(92. 5±1. 5)分,均达优。结论保留髂胫束止点Gerdy结节截骨外侧入路治疗单纯后外侧胫骨平台骨折临床疗效较好。
Objective To investigate the clinical therapeutic effect of simple posterolateral tibial plateau fractures via Gerdy tuberosity osteotomy anterolateral approach with reserving the insertion of the iliotibial band. Methods The 16 patients of the simple posterolateral tibial plateau fractures were treated by Gerdy tuberosity osteotomy anterolateral approach with reserving the insertion of the iliotibial band. X-ray film was used to evaluate fracture healing. The followup process was recorded: the ROM of the knee joint,the degree of articular surface collapse,and loosening or fracture of the internal fixation. HSS score was used to assess the knee function. Results All patients were followed up for 15～ 20 months. All surgical incision were primary healed. Patients had no complications such as incision infection,important vascular nerve injury,rearward displacement of the posterior bone block,loosening or fracture of the internal fixation. Patients showed an obscure fracture line on the X-ray film at 3 months postoperatively,and the fracture line disappeared at 12 months postoperatively. At the final follow-up,the ROM of the knee stretched from-3° to 5° and flexed from 100° to 145°. The collapse of the tibial plateau articular surface was 0 ～ 4( 2. 0 ± 0. 5) mm,and the score of the HSS knee function score ranged from 90 ～ 96( 92. 5 ± 1. 5),all cases were excellent. Conclusions It is better to treat the simple posterolateral tibial plateau fractures via Gerdy tubercle osteotomy anterolateral approach with reserving the insertion of the iliotibial band.
Objective To investigate the clinical therapeutic effect of simple posterolateral tibial plateau fractures via Gerdy tuberosity osteotomy anterolateral approach with reserving the insertion of the iliotibial band. Methods The 16 patients of the simple posterolateral tibial plateau fractures were treated by Gerdy tuberosity osteotomy anterolateral approach with reserving the insertion of the iliotibial band. X-ray film was used to evaluate fracture healing. The followup process was recorded: the ROM of the knee joint,the degree of articular surface collapse,and loosening or fracture of the internal fixation. HSS score was used to assess the knee function. Results All patients were followed up for 15～ 20 months. All surgical incision were primary healed. Patients had no complications such as incision infection,important vascular nerve injury,rearward displacement of the posterior bone block,loosening or fracture of the internal fixation. Patients showed an obscure fracture line on the X-ray film at 3 months postoperatively,and the fracture line disappeared at 12 months postoperatively. At the final follow-up,the ROM of the knee stretched from-3° to 5° and flexed from 100° to 145°. The collapse of the tibial plateau articular surface was 0 ～ 4( 2. 0 ± 0. 5) mm,and the score of the HSS knee function score ranged from 90 ～ 96( 92. 5 ± 1. 5),all cases were excellent. Conclusions It is better to treat the simple posterolateral tibial plateau fractures via Gerdy tubercle osteotomy anterolateral approach with reserving the insertion of the iliotibial band.
引文
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[2]罗从风,胡承方,高洪,等.基于CT的胫骨平台骨折的三柱分型[J].中华创伤骨科杂志,2009,11(3):201-205.
[3]徐亚风,罗从风,王驭恺,等.累及后柱的SchatzkerⅡ型胫骨平台骨折手术治疗失败的原因分析[J].临床骨科杂志,2015,18(6):722-725.
[4]陈红卫,赵钢生,张根福,等.改良的前外侧入路治疗胫骨平台后外侧骨折[J].临床骨科杂志,2012,15(5):549-551.
[5]王松柏,黄淑明,谷吕敏.改良后外侧入路外侧钢板固定治疗胫骨平台后外侧骨折[J].临床骨科杂志,2017,20(1):97-99.
[6] Johnson E E,Timon S,Osuji C. Surgical technique:TscherneJohnson extensile approach for tibial plateau fractures[J]. Clin Orthop Relat Res,2013,471(9):2760-2767.
[7]俞旭东,陈兵乾,盛晓文. MIPPO双钢板固定与单钢板加空心螺钉固定治疗SchatzkerⅤ、Ⅵ型胫骨平台骨折疗效比较[J].临床骨科杂志,2017,20(3):344-347.