关节内截骨治疗陈旧性胫骨平台骨折

Treatment of Old Tibial Plateau Fractures with Intra-articular Osteotomy

摘要:

目的 介绍关节内截骨治疗陈旧性胫骨平台骨折的手术技术和初步临床结果。方法 15例陈旧性胫骨平台关节内骨折行关节内截骨治疗。显露原始骨折线，骨折未愈时经原始骨折线插入骨刀，劈开骨折块行关节内截骨；骨折已愈时在畸形最明显处打入两枚平行的克氏针，沿克氏针行关节内截骨。截骨块翻开后，骨刀插入软骨下骨撬拨，恢复胫骨平台高度，骨缺损区植骨，支撑钢板固定。结果15例患者均获随访，随访时间12～36（18.53±6.91）月。随访过程中无感染、皮肤坏死、血管神经损伤等并发症，无内固定松动和断裂、骨折复位丢失等并发症。所有患者骨折均愈合，临床愈合时间12～24（19.27±3.08）周。末次随访时Lysholm膝关节评分为82-94 (89.87±4.60)分，优良率：93.3%。结论 关节内截骨术能够有效恢复胫骨平台关节面的平整性、重建下肢力线，在陈旧性胫骨平台关节内骨折中具有较好的疗效。

Abstract:

Objective To introduce the surgical techniques and preliminary clinical results of intra-articular osteotomy for the treatment of old tibial plateau fractures. Methods 15 cases of old tibial plateau intra-articular fractures were treated with the intra-articular osteotomy. Specially，expose the original fracture line firstly, if the fracture is not healed, an osteotome was insert through the original fracture line to split the fracture block for intra-articular osteotomy; if the fracture has healed, two parallel Kirschner wires are inserted into the most obvious area of the deformity, and intra-articular osteotomy is performed along the Kirschner wire. After the osteotomy block is opened, an osteotome is inserted under the cartilage to restore the height of the tibial plateau, and the bone defect area is implanted with bone and fixed with supporting steel plates. Results All 15 patients were followed up with an average period of 12～36 (18.53±6.91) months. During the follow-up, there were no complications such as infection, skin necrosis, vascular and nerve injury, loosening and fracture of internal fixation, and loss of fracture reduction. All fractures were union, and the clinical fracture healing time was 12-24 (19.27 ± 3.08) weeks. The Lysholm Knee Score was 82-94 (89.87 ± 4.60) at the last follow-up, with the total excellent and good rate was 93.3%. Conclusion Intra-articular osteotomy can effectively recover the articular surface of the tibial plateau, restore the lower extremity force line, with a good curative effect in the treatment of old tibial plateau intra-articular fractures.