应用塌陷骨块顶复器治疗SchatzkerⅡ、Ⅲ型胫骨平台骨折

doi:10.3877/cma.j.issn.1673-9450.2021.02.006

目的

探讨应用塌陷骨块顶复器治疗SchatzkerⅡ、Ⅲ型胫骨平台骨折的临床效果。

方法

2019年8月至今，汕头大学附属粤北人民医院创伤骨科应用塌陷骨块顶复器治疗SchatzkerⅡ、Ⅲ型胫骨平台骨折患者8例；其中Ⅱ型骨折4例，Ⅲ型骨折4例。所有患者均应用塌陷骨块顶复器复位胫骨平台关节面的塌陷骨折，经皮微创植入接骨板固定骨折端。采集手术时间、术中失血量等数据。术后定期随访，复查影像学检查；进行膝关节HSS评分和Rasmussen影像学评分评估患膝关节功能恢复情况；记录患膝关节屈曲角度和丢拐下床负重时间。

结果

8例患者均获随访，随访时间10.00～14.00个月，平均( 11.50±1.32 ) 个月。所有患者骨折10个月内均骨性愈合。丢拐下床负重时间5～8周，平均( 5.88±1.05) 周。末次随访时，膝关节屈曲度为95.00°～125.00 °，平均(111.00±10.69) °；Rasmussen影像学评分优良率达100%；膝关节HSS评分78.00～90.00分，平均(84.25±4.89) 分。

结论

应用塌陷骨块顶复器能将胫骨平台的塌陷骨折块解剖复位，恢复胫骨平台关节面平整；经皮微创植入钢板内固定，可最大程度地减少软组织和膝关节的损伤。术后疗效好，是治疗SchatzkerⅡ、Ⅲ型胫骨平台骨折的有效方法。

关键词: 骨折, 胫骨平台, 骨块顶复器, 微创

Objective

To evaluate the clinical effectiveness of special fracture block reduction device in mininally invasive treatment for Schatzker typeⅡand Ⅲ tibial plateau fractures.

Method

From August 2019 to now, eight patients admitted to the Department of Orthopedic Surgery of Yuebei People′s Hospital Affiliated to Shantou University who suffered from Schatzker typeⅡand Ⅲ tibial plateau fractures were included into the study, there were four cases of typeⅡand four cases of type Ⅲ.All patients were treated with special fracture block reduction device .The treatment was evaluated according to the surgical time and blood loss, and functional outcomes were evaluated according to HHS scores and Rasmussen radiological scoring system. Time to get out of bed and load was scored.

Results

All 8 patients were followed up for 10.00-14.00 months, with an average of (11.50±1.32 ) months. Time to get out of bed and load was 5 to 8 weeks, with an average of(5.88±1.05) weeks. All the fratures healed within 10 months postoperatively.At the last follow-up, the flexion of knee joint was 95.00° to 125.00 °, with an average of (111.00±10.69)°. The satisfaction rate was 100% according to Rasmussen radiological scoring system, and the mean HHS score was 78.00 to 90.00 points, with an average of (84.25±4.89) points.

Conclusion

Special fracture block reduction device is tested to be a feasible and worthwhile alternative for Schatzker typeⅡand Ⅲ tibial plateau fractures.

Key words: Fractures, bone, Tibial plateal, Fracture block reduction device, Minimally invasive

图1 环钻三件套

图2 术中将环钻中套更换为骨窗环钻

图3 应用塌陷骨块顶复器治疗右胫骨平台Schatzker Ⅲ型骨折。A、B示术前X线正、侧位；C示术前三维CT大体观；D、E、F示术前三维CT冠状位、矢状位及横切位；G示术中复位前透视照；H、I示术中在床边X线监视下，置入导针至塌陷骨块下；J、K示经导针开骨道；L、M、N示术中经过骨块顶复器，关节面塌陷骨块复位成功；O示术中小切口植入钢板；P示术中切口照；Q、R、S、T、U、V、W、X示术后影像学表现为骨折端复位，胫骨力线良好，关节面恢复平整，其中Q、R示术后X线正侧位，S、T、U示术后三维CT大体观，V、W、X示术后三维CT矢状位、冠状位及横切位

图4 应用塌陷骨块顶复器治疗右胫骨平台Schatzker Ⅱ型骨折。A、B示术前X线正侧位；C、D、E示术前三维CT矢状位、冠状位及横切位；F、G示术前三维CT大体观；H、I、J、K示术中在床边X线监视下，置入导针至塌陷骨块下；经导针开骨道；L、M示术中经过骨块顶复器，关节面塌陷骨块复位成功；N示术中小切口植入钢板；O示术中切口照；P、Q、R、S、T、U、V、W、X示术后影像学表现为塌陷骨折块复位良好，关节面平整，其中P、Q示术后X线正侧位， R、S、T示术后三维CT矢状位、冠状位及横切位；U、V示术后三维CT大体观；W、X示术后膝关节功能恢复良好，术后5周弃拐行走，术后8个月骨折端端骨性愈合

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Mininally invasive treatment for Schatzker typeⅡand Ⅲ tibial plateau fractures using special fracture block reduction device

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Mininally invasive treatment for Schatzker typeⅡand Ⅲ tibial plateau fractures using special fracture block reduction device