关节内截骨治疗陈旧性胫骨平台骨折（开放获取）

Intra-articular osteotomy for old tibial plateau fractures (Open Access)

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患者行关节内截骨治疗。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 2 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] 所有手术均顺利完成，术中无血管、神经损伤等并发症。手术时间平均 （119.1± 26.3）min。所有患者骨折均愈合，临床愈合时间平均（19.3±3.1）周。末次随访时 Lysholm 膝关节评分平均（89.9±4.6）分，优良率 93.3%。均无内固定松动和断裂、骨折复位丢失等并发症发生。[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治疗中具有较好的疗效。

Abstract:

[Objective] To introduce the surgical techniques and preliminary clinical results of intra-articular osteotomy for old tibial plateau fractures. [Methods] A total of 15 patients underwent intraarticular osteotomy for old intraarticular fracture of the tibial plateau. As the original fracture line was identified if the fracture was not healed, an osteotome was inserted through the original fracture line, and the fracture block was split and the intra-articular osteotomy was performed. If the fracture was healed, two parallel Kirschner pins were inserted at the most obvious point of the deformity, and the intra-articular osteotomy was performed along the Kirschner pins. The osteotome was inserted to the subchondral bone and pry to restore the height of the tibial plateau, and bone grafts were implanted in the bone defect area to support, finally plate fixation was conducted. [Results] All the patients were operated successfully without complications such as vascular and nerve injury, while with operation time of (119.1±26.3) min. All the osteotomy were healed with a mean clinical healing time of (19.3± 3.1) weeks. At the last follow-up, Lysholm's knee joint score was of (89.9±4.6), with the excellent and good rate of 93.3%. There were no complications such as loosening of internal fixation, fracture and loss of correction. [Conclusion] This intraarticular osteotomy does effectively restore the congruity of the articular surface of the tibial plateau and reconstruct the alignment of the lower extremity, and has a good effect for old intraarticular fracture of the tibial plateau.