镜下撬顶复位植骨填充治疗Schatzke III型胫骨平台骨折

Arthroscopic crowbar reduction combined with bone grafting for treatment of Schatzke type III tibial plateau fractures

摘要:

[目的] 介绍镜下撬顶复位植骨填充治疗 Schatzke III 型胫骨平台骨折的手术技术和初步临床效果。[方法] 2017 年 1 月—2018 年 1 月，对 16 例 Schatzke III 型胫骨平台骨折患者采用关节镜监视下撬顶复位，植入同种异体骨，并以自体骨栓填塞固定进行治疗。首先建立标准膝关节镜内外侧入路，利用前叉定位器确定胫骨平台塌陷的中心点，调整好角度并钻入 1 枚导针。利用骨软骨移植系统中取骨器，在导针的引导下，取出长约 1.5 cm 的圆柱状骨栓。使用骨软骨移植系统中配套的平头圆形顶棒，由所建立的骨通道直达塌陷胫骨平台下方，并在关节镜监视下缓慢进行撬顶，使胫骨平台恢复平整。然后将同种异体骨由取骨器的空腔塞入复位平台的下方，并在关节镜监视下再次用平头圆形顶棒打压实。最后待植骨充分后，将所取骨栓填塞至骨窗中。[结果] 所有患者均顺利完成手术，无严重并发症，随访 24~40 个月。与术前相比，末次随访时膝关节屈伸活动度 (ROM)、VAS 评分和 IKDC 评分均显著改善(P＜0.05)。[结论]关节镜下撬顶复位植骨填充治疗 Schatzke III 型胫骨平台骨折具有直视下复位和手术创伤小的优点，取得良好疗效。

Abstract:

[Objective] To introduce the surgical technique and preliminary clinical results of arthroscopic crowbar reduction com- bined with bone grafting for treatment of Schatzke type III tibial plateau fractures. [Methods] From January 2017 to January 2018, a total of 16 patients with Schatzke III tibial plateau fracture were treated with arthroscopic crowbar reduction, bone allografting and autologous bone plug fixation As standard anteromedial and anterolateral portals for knee arthroscopy was established, the concave center of tibial plateau collapse was positioned with a ACL guider, and a guide wire was inserted following the ACL guider in a proper angle. Using the bone extrac- tor of the osteochondral transplantation system, a cylindrical bone plug with a length of about 1.5 cm was removed under the guidance of the guide wire. Subsequently, the tibial plateau collapse was reduced to the normal level by slowly pry the roof with a crowbar under arthroscop- ic monitoring. The bone allografts were inserted into the bone tunnel and packed firmly to the upper part of the tunnel just under subchon- dral bone to maintaining the fracture reduction. Finally, the autologous bone plug harvested previously was inserted back. [Results] All pa- tients had surgical procedures performed successfully without serious complications, and were followed up for 24~40 months. The knee flex- ion- extension range of motion (ROM) , VAS and IKDC scores significantly improved at the latest follow up compared with those before op- eration (P＜0.05) . [Conclusion] This arthroscopic crowbar reduction combined with bone grafting has advantages of reduction under direct vision and minimally invasive operation, does achieve satisfactory clinical outcomes for Schatzke type III tibial plateau fractures.