双反牵引、微创复位及raft技术治疗后内及后外侧胫骨平台骨折

doi:10.3877/cma.j.issn.2096-0263.2018.05.002

中华老年骨科与康复电子杂志 ›› 2018, Vol. 04 ›› Issue (05) : 261 -265. doi: 10.3877/cma.j.issn.2096-0263.2018.05.002

所属专题：文献；

创新技术

双反牵引、微创复位及raft技术治疗后内及后外侧胫骨平台骨折

亢世杰¹, 胡义明¹, 鲍飞龙¹, 黄东生¹, 江涛¹, 刘涛¹^,^†(

)

^1. 266035　山东大学齐鲁医院（青岛）创伤骨科

收稿日期:2018-08-03 出版日期:2018-10-05
通信作者: 刘涛
基金资助:
青岛市医疗卫生重点学科建设项目(QDZDXK-A-2017005)

Posteromedial and posterolateral tibial plateau fractures after homeopathic double reverse traction, minimally invasive reduction and raft technique

Shijie Kang¹, Yiming Hu¹, Feilong Bao¹, Dongsheng Huang¹, Tao Jiang¹, Tao Liu¹^,^†()

^1. Department of Traumatology, Qilu Hospital of Shandong University, Qingdao 266035, China

Received:2018-08-03 Published:2018-10-05
Corresponding author: Tao Liu
About author:
Corresponding author: Liu Tao, Email: ltortho@163.com

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目的

分析双反牵引闭合复位，内外侧经皮置入双钢板治疗后内及后外侧胫骨平台骨折的效果，评估复位质量及功能恢复情况。

方法

回顾性收集2015年9月至2017年12月，山东大学齐鲁医院（青岛）创伤骨科收治的后内及后外侧胫骨平台骨折19例，其中男性11例，女性8例，年龄37~73岁，平均56.71岁。均采取双反牵引闭合复位，内外侧经皮置入双钢板治疗术后给予X线及三维CT再次评估复位情况。同时随访评估功能恢复情况。

结果

17例患者获得随访，随访时间6~14个月（平均10.1个月），骨折均获得愈合，无畸形愈合及骨不连。1例切口愈合不良，经换药后切口愈合。采用美国特种外科医院（HSS）膝关节评分，优14例，良3例。

结论

应用双反牵引、微创技术植入钢板及双钢板raft技术固定治疗后内及后外侧胫骨平台骨折具有术中快速复位，软组织并发症少，可避免骨折塌陷，畸形愈合优点。这种方法是治疗后内侧及后外侧胫骨平台骨折的有效手段，值得临床推荐。

关键词: 胫骨骨折, 外科手术，微创性, 内固定

Objective

To analyse the effects of homeopathic double-reverse traction with medial and lateral percutaneous double plate in the treatment for posteromedial and posterolateral tibial plateau fractures, and further analysis the quality of restoration and functional recovery.

Methods

A retrospective collection of 19 cases of posteromedial and posterolateral tibial plateau fractures in the department of Trauma and Orthopaedics of Qilu Hospital from September 2015 to December 2017, including 11 males and 8 females, aged 37-73 years old, with an average of 56.71 years old. All patients underwent homeopathic double-reverse traction closed reduction and medial and lateral percutaneous double plate were used, reduction were using X-ray and three-dimensional CT scan. Meanwhile functional recovery were followed-up.

Results

Seventeen patients were followed up for 6 to 14 months (mean 10.1 months). All fractures were healed without malunion and nonunion. One case had poor healing of the incision, and the incision healed after dressing change. Patients were evaluated with the US Special Surgery Hospital (HSS) knee score, excellent in 14 cases, and good in 3 cases.

Conclusions

The posteromedial and posterolateral tibial plateau fractures with homeopathic double-reverse traction, minimally invasive technique and double-plate raft technique have rapid intraoperative reduction and less soft tissue complications, which can avoid fracture collapse and malformation. This method is an effective method for the treatment of posteremedial and posterolateral tibial plateau fractures and worthy clinical recommendation.

Key words: Tibial fractures, Surgical procedures, Minimally invasive, Internal fixation

图1~13 男性，28岁，骑电动车车摔伤，诊断为左胫骨平台骨折。图1~3术前X线正侧位及CT示胫骨平台后内及后外侧型骨折；图4术中采用双反牵引进行顺势牵引复位；图5~7术中采用顶棒将不平整的关节面逐步敲击复位；图8~12术后正侧位X线片及三维CT；图13术后留置引流条

[1]	中华创伤骨科杂志编辑委员会.胫骨平台骨折诊断与治疗的专家共识[J].中华创伤骨科杂志, 2015, 17(1): 3-7.
[2]	Albuquerque RP, Hara R, Prado J, et al. Epidemiological study on tibial plateau fractures at a level I trauma center [J]. Acta Ortop Bras, 2013, 21(2): 109-115.
[3]	田野，王娟，陈伟. 2003年-2013年河北医科大学第三医院成人胫骨平台骨折的流行病学分析[J].中华创伤骨科杂志, 2015, 17(5): 424-427.
[4]	罗从风，胡承方，高洪,等.基于CT的胫骨平台骨折的三柱分型[J].中华创伤骨科杂志, 2009, 11(3): 201-205.
[5]	Haertsch PA. The blood supply to the skin of the leg a post-mortem investigation [J]. Br J Plast Surg, 1981, 34(4): 470-477.
[6]	Schatzker J, McBroom R, Bruce D. The tibia1 plateau fracture. The Toronto experience 1968-1975 [J]. Clin Orthop Relat Res, 1979, 138: 94-104.
[7]	肖睿，唐强，李伟, 等. 螺旋CT三维重建在胫骨平台骨折中的应用[J]. 中华创伤骨科杂志, 2005, 7(6): 523-525.
[8]	Brunner A, Horisberger M, Ulmar B, et a1. Classification systems for tibial plateau fractures；does computed tomography scanning improve their reliability? [J]. Injury, 2010, 41(2): 173-178.
[9]	Moore TM, Patzakis MJ. Harvey JP. Tibial plateau fractures: definition, demographics, treatment rationale, and Long-Term results of close traction management or operative redution [J]. J Orthop Trauma, 1987, 1(2): 97-119.
[10]	Tscherne H, Lobenhoffer P. Tibial plateau fractures. Management and expected results [J]. Clin Orthop Relat Res, 1993, 292: 87-100.
[11]	Momaya AM, Hlavace K, Etier B, et al. Risk factors for infection after operative fixation of tibial plateau fractures [J]. Injury, 2016, 47(7): 1501-1505.
[12]	Zhao XW, Ma JX, Ma XL, et al. A meta-analysis of external fixation versus open reduction and internal fixation for complex tibial plateau fractures [J]. Int J Surg, 2017, 39: 65-73.
[13]	Lee TC, Huang HT, Lin JC, et al. Bicondylar tibial plateau fracture treated by open reduction and fixation with unilateral locked plating [J]. Kaohsiung J Med Sci, 2013, 29(10): 568-577.
[14]	Weaver MJ, Harris MB, Strom AC, et al. Fracture pattern and fixation type related to loss of reduction in bicondylar tibial plateau fractures [J]. Injury, 2012, 43(6): 864-869.
[15]	Cift H, Cetik O, Kalaycioglu B, et al. Biomechanical comparison of plate-screw and screw fixation in medial tibial plateau fractures (Schatzker 4). A model study [J]. Orthop Traumatol Surg Res, 2010, 96(3): 263-267.
[16]	Lobenhoffer P, Gerich T, Bertram T, et al. Particular posteromedial and posterolateral approaches for the treatment of tibial head fractures [J]. Unfallchirurg, 1997, 100(12): 957-967.
[17]	Carlson DA. Posterior bieondylar tibial plateau fractures [J]. J Orthop Trauma, 2005, 19(2): 73-78.
[18]	Ruffolo MR, Gettys FK, Montijo HE, et al. Complications of High-Energy bicondylar tibial plateau fractures treated with dual plating through 2 incisions [J]. J Orthop Trauma, 2015, 29(2): 85-90.
[19]	Giannetti S, Bizzotto N, Stancati A, et al. Minimally invasive fixation in tibial plateau fractures using an pre-operative and intra-operative real size 3D printing [J]. Injury, 2017, 48(3): 784-788.

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