| 经外侧平台前缘骨折线与胫前开窗治疗胫骨平台前外侧柱骨折合并后外侧柱塌陷的疗效比较 |
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Received:June 11, 2024
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| 作者 | Author | 单位 | Unit | E-Mail |
| 孟乘飞 |
MENG Cheng-fei |
武汉中西医结合骨科医院 武汉体育学院附属医院骨科, 湖北 武汉 430079 |
Department of Orthopaedics, Wuhan Orthopaedics Hospital of Integrated Chinese & Western Medicine the Affiliated Hospital of Wuhan Sports University, Wuhan 430079, Hubei, China |
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| 王冠清 |
WANG Guan-qing |
武汉中西医结合骨科医院 武汉体育学院附属医院骨科, 湖北 武汉 430079 |
Department of Orthopaedics, Wuhan Orthopaedics Hospital of Integrated Chinese & Western Medicine the Affiliated Hospital of Wuhan Sports University, Wuhan 430079, Hubei, China |
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| 罗程 |
LUO Cheng |
武汉中西医结合骨科医院 武汉体育学院附属医院骨科, 湖北 武汉 430079 |
Department of Orthopaedics, Wuhan Orthopaedics Hospital of Integrated Chinese & Western Medicine the Affiliated Hospital of Wuhan Sports University, Wuhan 430079, Hubei, China |
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| 刘修华 |
LIU Xiu-hua |
武汉中西医结合骨科医院 武汉体育学院附属医院骨科, 湖北 武汉 430079 |
Department of Orthopaedics, Wuhan Orthopaedics Hospital of Integrated Chinese & Western Medicine the Affiliated Hospital of Wuhan Sports University, Wuhan 430079, Hubei, China |
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| 凌泽喜 |
LING Ze-xi |
武汉中西医结合骨科医院 武汉体育学院附属医院骨科, 湖北 武汉 430079 |
Department of Orthopaedics, Wuhan Orthopaedics Hospital of Integrated Chinese & Western Medicine the Affiliated Hospital of Wuhan Sports University, Wuhan 430079, Hubei, China |
690429797@163.com |
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| 期刊信息：《中国骨伤》2025年38卷，第3期，第265-272页 |
| DOI：10.12200/j.issn.1003-0034.20230205 |
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目的: 比较经外侧平台前缘骨折线与胫前开窗复位治疗胫骨平台前外侧柱骨折合并后外侧柱塌陷的临床疗效。
方法: 回顾性分析2016年1月至2021年12月收治的52例SchatzkerⅡ型胫骨平台前外侧柱骨折合并后外侧柱塌陷患者,根据骨折复位方式分为两组。经骨折线组27例,男19例,女8例;年龄26~62(43.2±11.4)岁;受伤至手术时间4~8(5.8±1.5) d;采用经外侧平台前缘骨折线复位内固定治疗。开窗组25例,男13例,女12例;年龄22~69(40.8±11.1)岁;受伤至手术时间4~8(6.0±1.4) d;采用胫骨开窗复位内固定治疗。比较两组植骨量、手术时间、骨折愈合时间及并发症情况。比较术前、术后2 d及6个月外侧平台关节面塌陷深度、外侧胫骨平台后倾角(posterior slope angle,PSA)。分别于术后2 d及6个月采用美国特种外科医院(Hospital for Speical Surgery,HSS)膝关节评分进行膝关节功能评价。采用膝关节Rasmussen解剖评分评定骨折复位情况。
结果: 两组均获得随访,时间12~24(16.0±3.4)个月。两组患者随访期间未发现骨折再移位、膝关节内外翻畸形、膝关节不稳。经骨折线组1例伤口出现脂肪液化,2例出现下肢肌间静脉血栓;开窗组1例出现关节僵硬,1例出现下肢肌间静脉血栓,1例伤口浅表感染;两组并发症比较,差异无统计学意义(P>0.05)。经骨折线组植骨量、手术时间、骨折愈合时间分别为(3.6±2.3) cm3、(123.4±18.2) min、(13.8±1.8)周,开窗组分别为(4.8±1.8) cm3、(135.5±22.5) min、(15.2±2.0)周,两组比较差异有统计学意义(P<0.05)。术后2 d及6个月经骨折线组外侧平台关节面塌陷深度分别为(0.8±0.1)、(0.9±0.1) mm,小于开窗组(0.9±0.1)、(1.1±0.1) mm,差异有统计学意义(P<0.05);经骨折线组PSA分别为(9.4±1.5)°、(10.1±1.9)°,小于开窗组的(10.5±1.5)°、(11.3±1.9)°,差异有统计学意义(P<0.05);经骨折线组Rasmussen解剖评分分别为16(16,18)、16(14,16)分,优于开窗组16(16,16)分、14(14,16)分(P<0.05)。两组关节面塌陷深度、PSA及Rasmussen解剖评分均优于术前,差异有统计学意义(P<0.05)。术后2 d,两组HSS评分比较,差异无统计学意义(P>0.05)。术后6个月,经骨折线组胫骨平台HSS评分(86.7±3.6)分高于开窗组(84.1±3.91)分,差异有统计学意义(P<0.05)。两组术后6个月HSS评分优于术后2 d,差异有统计学意义(P<0.05)。
结论: 经外侧平台前缘骨折线与胫前开窗复位均可用于治疗胫骨平台前外侧柱骨折合并后外侧柱塌陷。与开窗复位相比经骨折线具有术中植骨少、手术时间更短、骨折愈合时间短、关节面复位效果更佳及膝关节功能恢复更好等优点。 |
| [关键词]:胫骨骨折 膝关节 骨折固定术,内 病例对照研究 |
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| Comparison of efficacy of anterolateral tibial plateau fracture line and anterior tibial fenestration for the treatment of anterolateral tibial plateau column fracture combined with posterolateral column collapse |
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Abstract:
Objective To compare clinical effect of anterior tibial plateau fracture line and anterior tibial fenestration reduction in treating anterolateral tibial plateau column fracture combined with posterior lateral column collapse.
Methods Fifty-two patients with Schatzker typeⅡ tibial plateau anterolateral column fracture combined with posterolateral column collapse admitted from January 2016 to December 2021 were retrospectively analyzed and divided into two groups according to fracture reduction methods. There were 27 patients in fracture line group,including 19 males and 8 females,aged from 26 to 62 years old with an average of (43.2±11.4) years old;the time from injury to operation ranged from 4 to 8 days with an average of (5.8±1.5) days;treated with reduction and internal fixation via fracture line of lateral platform front. There were 25 patients in fenestrate group,including 13 males and 12 females,aged from 22 to 69 years old with an average of (40.8±11.1) years old;the time from injury to operation ranged from 4 to 8 days with an average of (6.0±1.4) days;treated with tibial fenestration reduction and internal fixation. The amount of bone graft,operation time,fracture healing time and complications were compared between two groups. Posterior slope angle (PSA) and posterior slope angle of the lateral tibial plateau was compared before surgery,2 days and 6 months after surgery. The knee function was evaluated by Hospital for Speical Surgery (HSS) at 2 days and 6 months after surgery,respectively. Fracture reduction was evaluated by Rasmussen anatomic score of knee joint.
Results Both of group were followed up from 12 to 24 months (16.0±3.4) months. No redisplacement of fracture,internal and external inversion deformity of knee joint,or instability of knee joint were found between two groups during follow-up. In fracture line group,1 patient occurred wound fat liquefaction and 2 patients occurred lower limb intermuscular venous thrombosis occurred. In fenestration group,1 patient occurred joint stiffness,1 patient occurred lower limb intermuscular venous thrombosis,and 1 patient occurred superficial wound infection;there were no significant difference in complications between two groups (P>0.05). Bone graft volume,operative time and fracture healing time in fracture line group were (3.6±2.3) cm3,(123.4±18.2) min and (13.8±1.8) weeks,while in feneplast group were (4.8±1.8) cm3,(135.5±22.5) min and (15.2±2.0) weeks,respectively;the difference between two groups was statistically significant (P<0.05). The collapse depth of lateral platform articular surface at 2 days and 6 months after surgery were (0.8±0.1) and (0.9±0.1) mm in fracture line group,which were lower than those in fenestration group (0.9±0.1) and (1.1±0.1) mm,respectively (P<0.05). After 2 days and 6 months,,PSA in fracture line group were (9.4±1.5) ° and (10.1±1.9) °,respectively,which were lower than those in fenestration group (10.5±1.5) ° and (11.3±1.9) ° (P<0.05). Rasmussen anatomical scores in fracture line group at 2 days and 6 months were 16(16,18) and 16(14,16) points,respectively,which were better than those in fenestrated group (16,16) and 14(14,16) points (P< 0.05). The collapse depth,PSA and Rasmussen anatomical score between two groups were better than those before surgery (P<0.05). There was no significant difference in HSS score between two groups at 2 days after surgery (P>0.05). At six months after surgery,HSS score in fracture line group (86.7±3.6) was higher than that in fenestration group (84.1±3.91) (P<0.05). HSS score at 6 months after surgery was better than that at 2 days after surgery (P<0.05).
Conclusion Both anterior tibial plateau fracture line and anterior tibial fenestration could be used to treat anterolateral tibial plateau column fracture with posterior lateral column collapse. Compared with fenestration group,transfracture line group had advantages of less intraoperative bone grafting,shorter operative time,shorter fracture healing time,better articular surface reduction effect and better knee functional recovery. |
| KEYWORDS:Tibial fracture Knee joint Fracture fixation,internal Case-control study |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 孟乘飞,王冠清,罗程,刘修华,凌泽喜.经外侧平台前缘骨折线与胫前开窗治疗胫骨平台前外侧柱骨折合并后外侧柱塌陷的疗效比较[J].中国骨伤,2025,38(3):265~272 |
| 英文格式: | MENG Cheng-fei,WANG Guan-qing,LUO Cheng,LIU Xiu-hua,LING Ze-xi.Comparison of efficacy of anterolateral tibial plateau fracture line and anterior tibial fenestration for the treatment of anterolateral tibial plateau column fracture combined with posterolateral column collapse[J].zhongguo gu shang / China J Orthop Trauma ,2025,38(3):265~272 |
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