锁定板和前后拉力螺钉固定胫骨前外侧平台塌陷骨折△

Lateral locking plate and antero-posterior lag screws for fixation of collapsed fractures of the anterolateral tibial plateau

摘要:

[目的]介绍外侧锁定板和前后拉力钉固定胫骨前外侧平台塌陷骨折的手术技术和初步临床效果。[方法]对 26 例胫骨平台骨折分型为 Schatzker Ⅱ型患者行上述手术治疗。术前采用 Mimics 软件在健侧胫骨近端数字模型确定锁定板及螺钉位置，测量关节面下前后拉力钉置入方向及长度。术中采用膝关节前外侧入路，骨折复位固定后经胫骨平台前外侧入路置入外侧锁定钛板，依照健侧膝关节术前 Mimics 软件测量前后拉力钉置入方向及长度，指导前后拉力钉在矢状位方向置入 2 枚合适长度螺钉。[结果]手术时间平均(72.6±4.3)min。术中出血量平均(85.7±6.5)ml。术后 1 年膝关节伸直完全正常，HSS 功能评分显著增加 (P＜0.05)。术后 1 年，关节面塌陷高度显著减少 (P＜0.05)，Rasmussen 放射学评分显著改善，所有患者于 12~18 周骨折愈合。术后 1 年 CT 片示骨折复位良好，关节面无塌陷出现。[结论]外侧锁定板前后拉力钉固定胫骨前外侧平台塌陷骨折临床疗效满意，避免继发性的关节面塌陷发生。

Abstract:

[Objective] To introduce the surgical technique and preliminary clinical results of lateral locking plate and antero-posteri- or lag screws for fixation of collapsed fractures of the anterolateral tibial plateau. [Methods] A total of 26 patients received abovesaid surgi- cal procedures for Schatzker type Ⅱ tibial plateau fractures. Before operation, Mimics software was used to determine the position, direc- tion and length of the locking plate and antero-posterior lag screws in the digital model of the proximal tibia on the healthy side. After an anterolateral incision was made to explore the proximal tibia, the fractures were reduced and fixed with the lateral locking titanium plate se- lected according to the preoperative measurement with Mimics software on the contralateral proximal tibia, while two antero-posterior lag screws in appropriate lengths were implanted in the sagittal direction. [Results] The operation lasted for (72.6±4.3) min, associated with in- traoperative blood loss of (85.7±6.5) ml. All the patients resumed complete knee extension-flexion range of motion with significantly im- proved HSS score 1 year after operation (P＜0.05). Radiographically, the depth of articular surface collapse significantly reduced (P＜0.05), while the Rasmussen radiology score significantly increased postoperatively compared with those preoperatively (P＜0.05). All patients got fracture healing in 12~18 weeks postoperatively. The CT images showed good fracture reduction without articular surface collapse 1 year af- ter operation. [Conclusion] The lateral locking plate and antero-posterior lag screws plateau do achieve satisfactory clinical outcomes for collapsed fractures of the anterolateral tibial plateau, which might avoid secondary articular surface collapse.