目的探讨两种复位顺序对手术治疗伴冠状面半脱位Schatzker Ⅳ型胫骨平台骨折的效果影响。
方法回顾性分析2020年6月至2023年10月期间福州市第二总医院骨科采用手术治疗的53例伴冠状面半脱位Schatzker Ⅳ型胫骨平台骨折患者资料。根据复位顺序不同分为两组：观察组25例，男16例，女9例；年龄（47.2±10.2）岁；术中先复位并临时固定冠状面半脱位，接着复位内侧平台后固定内、外侧平台。对照组28例，男13例，女15例；年龄（50.6±15.4）岁；采用传统方式术中先复位并临时固定内侧平台，再复位冠状面半脱位，最后固定内、外侧平台。比较两组患者的手术时间、术中出血量、骨折愈合时间，术后第2天胫骨近端内侧角、外侧平台增宽、冠状面半脱位率及Rasmussen评分优良率，以及末次随访时膝关节功能等。
结果两组患者术前一般资料比较差异均无统计学意义（ P>0.05），具有可比性。53例患者术后获（12.6±4.2）个月随访。两组患者的手术时间、术中出血量、骨折愈合时间及术后胫骨近端内侧角比较差异均无统计学意义（ P>0.05）。观察组患者术后Rasmussen评分优良率[100.0%（25/25）]显著高于对照组患者[78.6%（22/28）]，外侧平台增宽[（3.70±2.42）mm]显著小于对照组患者[（5.79±3.38）mm]，冠状面半脱位率[16.0%（4/25）]显著低于对照组患者[42.9%（12/28）]，末次随访时美国特种外科医院评分[（83.8±5.4）分]显著高于对照组患者[（80.0±6.5）分]，差异均有统计学意义（ P<0.05）。
结论与传统复位方式比较，术中先复位冠状面半脱位的复位顺序治疗伴冠状面半脱位Schatzker Ⅳ型胫骨平台骨折的近期疗效更佳，能有效减少患者术后外侧平台增宽，降低术后冠状面半脱位率。
ObjectiveTo evaluate the impacts of 2 reduction sequences on the surgical treatment of Schatzker type Ⅳ tibial plateau fractures with coronal plane subluxation.
MethodsA retrospective analysis was conducted of the 53 patients who had been treated for Schatzker type Ⅳ tibial plateau fractures with coronal plane subluxation at Department of Orthopaedics, Fuzhou Second General Hospital from June 2020 to October 2023. The patients were divided into 2 groups according to the 2 reduction sequences employed during surgery. In the observation group of 25 patients [16 males and 9 females with an age of (47.2±10.2) years], the coronal plane subluxation was first reduced and temporarily fixed, followed by reduction of the medial plateau, and fixation of both the medial and lateral plateaus. In the control group of 28 patients [13 males and 15 females with an age of (50.6±15.4) years], in the traditional manner, the medial plateau was first reduced and temporarily fixed, followed by reduction of the coronal plane subluxation and finally by fixation of both plateaus. Outcomes compared between the 2 groups included surgical duration, intraoperative blood loss, and fracture healing time. Additionally, postoperative outcomes were assessed on the second day after surgery using such parameters as medial proximal tibial angle, lateral plateau widening, rate of coronal plane subluxation, and Rasmussen score. Knee joint function was evaluated at the final follow-up.
ResultsNo significant differences were found between the 2 groups in baseline characteristics, ensuring comparability ( P>0.05). The mean follow-up duration for all patients was (12.6±4.2) months. There were no significant differences in surgical duration, intraoperative blood loss, fracture healing time or medial proximal tibial angle between the 2 groups ( P>0.05). The observation group demonstrated a significantly higher success rate by Rasmussen score (100.0% [25/25]) than the control group (78.6% [22/28]), significantly smaller postoperative lateral plateau widening [(3.70±2.42) mm] than the control group [(5.79±3.38) mm], a significant lower rate of coronal plane subluxation [16.0% (4/25)] than the control group [42.9% (12/28)], a significantly higher Hospital for Special Surgery (HSS) knee score [(83.8±5.4) points] than the control group [(80.0±6.5) points] (all P<0.05).
ConclusionCompared to the traditional reduction sequence, the modified reduction sequence prioritizing the reduction of coronal plane subluxation during surgery for Schatzker type Ⅳ tibial plateau fractures with coronal plane subluxation leads to superior short-term outcomes, effectively reduced widening of postoperative lateral tibial plateau and a decreased rate of coronal plane subluxation.
陈传远,许阳凯,王飚,等. 复位顺序对手术治疗伴冠状面半脱位Schatzker Ⅳ型胫骨平台骨折的效果影响研究[J]. 中华创伤骨科杂志,2025,27(03)：234-241.
DOI:10.3760/cma.j.cn115530-20240818-00343版权归中华医学会所有。
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陈传远：数据收集及分析、论文撰写；许阳凯：数据收集；王飚：手术操作；林凤飞：论文指导
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