经关节截骨治疗创伤后胫骨平台骨折内翻畸形
徐亚风;罗从风;唐波;孙辉;
摘要(Abstract):
[目的]探讨经关节截骨治疗陈旧性胫骨平台骨折内翻畸形的策略和临床效果。[方法]回顾2002年9月~2012年9月收治的陈旧性胫骨平台骨折内翻畸形患者48例。入院后制定个体化的翻修手术方案。术中矫正下肢力线,并选择恰当的锁定钢板对内侧、后侧骨块进行充分固定。术后视膝关节稳定程度尽早开始功能锻炼。[结果]随访骨折均愈合良好,愈合时间为13~23周(平均17.3周)。术后即刻与术后2年胫骨平台内翻角(TPA)及后倾角(PA)比较,差异无统计学意义(P>0.05),术后无切口浅表感染及骨不连,无内固定失效松动断裂。根据膝关节HSS评分,优39例(81.3%)、良6例、差1例,该病人行二次手术翻修。[结论]经关节截骨治疗创伤后胫骨平台骨折畸形愈合可获得良好的治疗效果。
关键词(KeyWords): 胫骨平台骨折;内翻畸形;经关节截骨
基金项目(Foundation):
作者(Author): 徐亚风;罗从风;唐波;孙辉;
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DOI:
参考文献(References):
- [1]Choo KJ,Morshed S.Postoperative complications after repair of tibial plateau fractures[J].J Knee Surg,2014,1:11-19.
- [2]Papagelopoulos PJ,Partsinevelos AA,Themistocleous GS,et al.Complications after tibia plateau fracture surgery[J].Injury,2006,6:475-484.
- [3]移平,谭明生,杨峰,等.胫骨内侧高位楔形截骨治疗膝内翻畸形的临床疗效观察[J].中国矫形外科杂志,2010,3:192-194.
- [4]胡承方,罗从风.胫骨近端力学指标与膝关节手术[J].国外医学(骨科学分册),2005,5:311-312,320.
- [5]施鸿飞,熊进,陈一心,等.胫骨平台骨折术后行内固定翻修的治疗策略[J].中国矫形外科杂志,2011,20:1682-1685.
- [6]罗从风,姜锐,周曼瑜,等.胫骨内侧平台骨折手术治疗失败的原因分析[J].中华创伤骨科杂志,2006,7:642-646.
- [7]周炎,瞿新丛,易成腊,等.胫骨平台骨折术后膝内翻畸形机制探讨[J].中国矫形外科杂志,2013,2:190-192.
- [8]Lustig S,Khiami F,Boyer P,et al.Post-traumatic knee osteoarthritis treated by osteotomy only[J].Orthop Traumatol Surg Res,2010,8:856-860.
- [9]Kerkhoffs GM,Rademakers MV,Altena M,et al.Combined intraarticular and varus opening wedge osteotomy for lateral depression and valgus malunion of the proximal part of the tibia.Surgical technique[J].J Bone Joint Surg Am,2009,1:101-115.
- [10]Marti RK,Kerkhoffs GM,Rademakers MV.Correction of lateral tibial plateau depression and valgus malunion of the proximal tibia[J].Oper Orthop Traumatol,2007,1:101-113.
- [11]Wasserstein D,Henry P,Paterson JM,et al.Risk of total knee arthroplasty after operatively treated tibial plateau fracture:a matchedpopulation-based cohort study[J].J Bone Joint Surg Am,2014,2:144-150.
- [12]Singh H,Singh VR,Yuvarajan P,et al.Open wedge osteotomy of the proximal medial tibia for malunited tibial plateau fractures[J].J Orthop Surg(Hong Kong),2011,1:57-59.
- [13]Luo CF,Sun H,Zhang B,et al.Three-column fixation for complex tibial plateau fractures[J].J Orthop Trauma,2010,11:683-692.
- [14]Zhang W,Luo CF,Putnis S,et al.Biomechanical analysis of four different fixations for the posterolateral shearing tibial plateau fracture[J].Knee,2012,2:94-98.
- [15]王振军,秦泗河,焦绍锋,等.Ilizarov技术结合矫形支具治疗复杂膝关节畸形的临床研究[J].中国矫形外科杂志,2013,17:1775-1777,1798.
- [16]Zorzi AR,Da Silva HG,Muszkat C,et al.Opening-wedge high tibial osteotomy with and without bone graft[J].Artif Organs,2011,3:301-307.
- [17]Turkmen F,Sever C,Kacira BK,et al.Medial opening-wedge high tibial osteotomy fixation with short plate without any graft,synthetic material or spacer[J].Eur J Orthop Surg Traumatol,2014,8:1549-1555.
- [18]Kerkhoffs GM,Rademakers MV,Altena M,et al.Combined intraarticular and varus opening wedge osteotomy for lateral depression and valgus malunion of the proximal part of the tibia[J].J Bone Joint Surg Am,2008,6:1252-1257.