胫骨平台骨折手术治疗方法研究进展

胫骨平台骨折以关节面塌陷和劈裂为基本特点,导致手术复位与固定困难,胫骨平台毗邻的膝关节软组织结构较多,阻碍对胫骨平台骨折的复位与固定,骨折伴发伤及手术损伤也会加剧膝关节稳定性的丢失,因此膝关节骨组织稳定性重建与周围软组织保护是胫骨平台骨折治疗难点,笔者就胫骨平台骨折治疗的手术入路、骨折固定技术、关节镜辅助复位内固定技术、球囊成形术和膝关节置换术、数字骨科技术及软组织损伤处理等方面的研究进展进行综述,为胫骨平台骨折的临床治疗提供借鉴。     

胫骨平台后侧解剖型钢板治疗胫骨平台后侧骨折的生物力学研究

目的 探讨胫骨平台后侧解剖型钢板的生物力学性能.方法 将25具新鲜冰冻成年尸体胫骨上端及匹配的股骨下端标本按随机数字表法分为四组.1具标本作为正常对照组(N组).其余24具均造成Schatzker Ⅵ型胫骨平台骨折,随机分为三组,每组8具,后侧分别采用胫骨平台后侧解剖型钢板(A组)、"T"形钢板(B组)、直型重建钢板(C组)固定,后两组为对照组,测试各组钢板的强度、刚度、扭转生物力学及失效载荷性能.结果 试验组复杂胫骨平台骨折的强度和刚度超过N组(P＞0.05),在扭转生物力学性能上接近N组(P＞0.05);试验组在强度、刚度、扭转生物力学性能和失效载荷性能优于B、C组(P＜0.05).结论 胫骨平台后侧解剖型钢板具有优越的生物力学性能,在治疗胫骨平台后侧骨折及膝关节的稳定性较其他内固定材料好,是胫骨平台后侧骨折固定较为理想的选择.     

胫骨平台骨折的分类与治疗

胫骨平台骨折也称胫骨髁部骨折,属胫骨近端的关节内骨折,可有不同程度的关节面压缩与移位,将影响膝关节的对合稳定性与运动。胫骨平台骨折约占所有骨折的1%,外侧平台骨折占55%～70%,内侧平台骨折占10%～23%,内外侧平台同时骨折占10%～30%。根据骨折的部位与移位程度,胫骨平台骨折有很多的分类方法。好的分类方法应该便于记忆和指导治疗。     

胫骨平台骨折的治疗进展

胫骨平台骨折是常见的关节内骨折,直接影响膝关节的功能,若处理不当,易出现膝关节不稳定,晚期发生膝关节退行性变。随着现代骨科的发展以及对胫骨平台骨折研究的不断深入,治疗方法在逐步改进和完善,治疗概念也不断更新。本文就近年来胫骨平台骨折治疗的进展作一综述。     

胫骨平台骨折的手术治疗

目的探讨胫骨平台骨折的手术治疗方法及内固定物的选择。方法回顾性分析我院1995年6月。2002年10月收治胫骨平台骨折并通过手术治疗的63例临床资料。结果46例随访1—6年,优26例,良14例,优良率86．9％;一般3例,差3例。结论对于移位的胫骨平台骨折,良好的复位、坚强的内固定、足量的植骨、关节稳定的重建、早期活动都是相当重要的。     

复杂性胫骨平台骨折21例治疗体会

我院自2008年1月～2009年5月收治复杂胫骨平台骨折21例．应用高尔夫型加T型支撑钢板内固定治疗胫骨平台复杂骨折，取得良好效果，现报道如下。     

胫骨平台骨折的CT应用和价值

胫骨平台骨折的ＣＴ应用和价值王书智孙丽敏叶彬许民生笔者将３３例３６个胫骨平台骨折的ＣＴ检查结果进行分析，并与Ｘ线平片对照，探讨其诊断价值。材料与方法从１９９３年１１月至１９９６年５月对３３例３６个胫骨平台骨折的患者做了ＣＴ检查，检查时间为外伤后２～４...     

胫骨平台骨折患者受损软骨细胞凋亡的临床研究

目的 探讨胫骨平台骨折患者关节内软骨细胞的急性改变及其与骨关节炎发生之间的可能关系。方法 对病程＜2周的胫骨平台骨折患者，在骨折复位时取少许受损关节软骨，利用透射电镜、末端脱氧核苷酸转移酶（TdT）介导的dUTP原位切口末端标记（TUNEL）等方法观察受损软骨细胞的改变。结果 胫骨平台骨折后，遭受冲击创伤的软骨在2周内其部分其部分细胞发生坏死及凋亡。结论 胫骨平台骨折后，关节内遭受冲击创伤的软骨细胞出现死亡，这可能是引起骨关节炎发生的原因之一。     

胫骨平台骨折影像学诊断的进展

胫骨平台骨折是骨科较常见的病例,大部分是复杂骨折,需要手术固定,是骨科治疗的难题之一,手术前的正确诊断和准确分型对治疗的成功与否起到关键作用。影像学检查作为胫骨平台骨折诊断和分型的依据,被临床医师十分重视。影像学检查方法主要是普通X线平片、CT、MR。由于胫骨平台解剖的特点及骨折的复杂性,仅凭普通X线平片单一的检查手段不能给临床提供完善的信息,影响到治疗及预后,需要多种影像检查方法相结合,互相补充,提高胫骨平台骨折诊断的正确率,给临床医生的治疗提供更加完善的信息。     

胫骨平台及髁间棘骨折的关节镜治疗

胫骨平台骨折和胫骨髁间棘骨折都是膝关节内的一种常见损伤,常导致关节功能障碍。治疗上多年来沿用传统的切开复位方法,手术创伤大。近年来,我们采用关节镜下微创治疗此类骨折,取得了很好的疗效。1临床资料1·1一般资料本组16例,男13例,女3例;年龄26~45岁,平均36.7岁。胫骨平台     

Insufficiency fractures of the tibial plateau

An insufficiency fracture of the tibial plateau may be the cause of knee pain in patients with osteoporosis. The diagnosis is usually not suspected until a bone scan is done, as initial radiographs are often negative or inconclusive and clinical findings are nonspecific and may simulate osteoarthritis or spontaneous. In five of 165 patients referred for bone scans due to nontraumatic knee pain, a characteristic pattern of intense augmented uptake of radionuclide confined to the tibial plateau led to a presumptive diagnosis of insufficiency fracture, later confirmed on radiographs.     

胫骨平台骨折的手术治疗

总结胫骨平台骨折手术治疗的临床效果。认为手术整复平整的平台关节面，稳定的内固定，恢复膝关节的稳定性和良好力线，术后早期合理康复计划，都是恢复膝关节良好功能的重要环节。     

Radiographic evaluation of tibial plateau fractures

Thorough radiographic evaluation of tibial plateau fractures is necessary in order to determine the extent and type of injury. Routine anteroposterior and lateral radiographs should be supplemented by oblique and horizontal beam lateral views. Tomography most accurately delineates fracture anatomy and thus plays a key role in planning treatment; the surgical approach is determined by the tomographic localization of the fracture fragments. The radiologist's understanding of tibial plateau fractures aids the orthopedic surgeon in the management of these patients.     

Fractures of the posterolateral tibial plateau

We reviewed the clinical records and operative notes of 28 patients with fractures of the posterolateral tibial plateau seen at our institution from 1949 to 1982. Five of the 28 patients had chronic depressions of the posterolateral tibial plateau after initial treatment elsewhere. All five were disabled because of significant functional instability when the knee was in flexion. There were 23 acute fractures, of which 4 were initially nondisplaced and treated nonoperatively. One nonoperative patient was lost to followup; the remaining three were rated as having had good or excellent results. Nineteen patients had acute depressed fractures and were treated operatively with open reduction, elevation of the depressed area, and bone grafting, with or without internal fixation. All patients treated operatively at the time of injury were seen for followup from 24 to 145 months postoperatively, with a mean followup of 59 months. One patient was lost to followup; the other 18 were rated using both objective and subjective criteria. Seventeen (94%) achieved a final rating of excellent or good; one patient (6%) achieved a rating of fair. We have observed these fractures occurring in a younger population and producing significant disability in activities requiring a stable knee in flexion. The depressed posterolateral tibial plateau fracture is best assessed by AP, lateral, and 45 degrees internal oblique views on radiographic examination. Because of continued disability caused by chronic, depressed fractures of this type, we recommend open reduction and bone grafting in acute cases to eliminate instability in flexion. This procedure produces good or excellent results in most cases.     

Arthroscopy-assisted operative management of tibial plateau fractures

This retrospective review evaluated the results of arthroscopy-assisted surgery for tibial plateau fractures in 45 patients with closed tibial plateau fractures. The fracture involved articular depression in 27 patients in whom lifting and bone grafting with autogenous corticocancellous iliac bone graft was required. In 23 patients there were also meniscal lesions, which were treated by partial resection in 16 and repaired in 7. Internal fixation was performed using screws in 36 knees and plate in 10 knees. Radiological results were evaluated according to the Resnic-Niwoyama criteria; mean follow-up was 36 months (range 14-72). There was no intraoperative complication in the series, but postoperatively there were one infection and one loss of correction. Results were satisfactory in 89% of cases, according the Rasmussen criteria. Arthroscopy is thus an excellent and minimally invasive method for assessment and treatment of tibial plateau fractures. The advantages are complete and anatomical reduction in the fractured articular surface and evaluation of other concomitant intra-articular pathology and entails only little additional morbidity, especially compared to arthrotomy.     

过伸型胫骨平台骨折的临床治疗

目的探讨过伸型胫骨平台骨折的临床治疗。方法回顾性分析2013年11月—2017年12月南京医科大学第一附属医院治疗的12例过伸型胫骨平台骨折。其中男性4例,女性8例;年龄24～65岁,平均53.6岁;致伤原因均为道路交通伤。患者采用屈曲位复位,植骨后使用内外侧钢板固定。观察患者术后平台后倾角、美国特种外科医院膝关节功能评分(HSS评分)、关节屈曲度以及并发症情况。结果术后X线片显示均获得解剖复位。术后均无膝关节反曲,患者均得到随访6～18个月,平均9.7个月。骨折愈合时间8～12周,平均10.0周。所有患者术后测量后倾角5°～9°(平均7.9°),术后半年5°～10°(平均7.7°)。HSS评分90～98分(平均93.6分)。术后半年关节屈曲度120°～145°(平均131°),伸直均为0°。术后无一例发生钢板及螺钉断裂现象。结论通过恢复正常后倾角及关节面平整,充分植骨及锁定钢板固定治疗过伸型胫骨平台骨折,效果良好,值得临床推荐。     

Idiopathic osteonecrosis of the medial tibial plateau

Osteonecrosis of the medial tibial plateau is characterized by acute pain on the medial aspect of the knee. Progression can lead to articular collapse and requires early diagnosis and treatment. We studied seven patients affected of idiopathic osteonecrosis of the tibial plateau. The mean age was 62 years and the mean follow-up 42 months. We performed roentgenograms in all patients, bone scans in three patients and magnetic resonance image (MRI) in five. MRI shows T1-weighted low-intensity signal and T2-weighted high-intensity signal with a surrounding area of intermediate low-intensity signal. An increased focal uptake was seen at bone scan. Histological findings showed necrotic bone with empty lacunae. Surgical treatment consisted of tibial subchondral drilling in four patients—two of them by failure of conservative treatment, and a total knee arthroplasty in other two. One patient had a satisfactory evolution with conservative treatment. Idiopathic osteonecrosis of the tibial plateau must be considered in elderly patients with knee pain over the medial tibial plateau. At early stages, decompression with tibial drilling must be considered. This procedure allows a prompt and effective relief of symptoms.