【摘要】 目的 比较外侧胫骨平台塌陷骨折两种复位方法的临床疗效。方法 回顾分析我院创伤骨科 2019 年 1 月至 2024 年 3 月采用手术治疗的 78 例外侧胫骨平台塌陷骨折患者的临床资料。按膝关节面复位方法分为开窗组和截骨组。记录两组一般资料、围术期、临床随访及影像测量数据，比较其差异性。结果 开窗组 48 例，截骨组 30 例，随访 13～71 个月，平均 (35.0±15.0) 个月。两组一般情况和围术期各项指标差异均无统计学意义。两组术后骨折愈合时间、各随访节点 Rasmussen 功能评分差异均无统计学意义。开窗组术后 2 例切口感染，截骨组术后 4 例关节僵硬。术后 3 个月时截骨组视觉模拟评分 (visual analogue scales，VAS)高于开窗组 (2.4±0.6 vs.2.0±0.7)，术后 3 个月和末次随访时截骨组膝关节伸-屈活动度 (range of motion，ROM) 均明显低于开窗组[(98.7±17.2) ° vs.(112.1±10.6) °，(122.3±15.9) ° vs.(130.0±9.1) °]，差异均有统计学意义 (P < 0.05)。术前关节面塌陷程度截骨组高于开窗组[(12.0±5.0) mm vs.(8.6±4.7) mm]，术前 Rasmussen 影像评分截骨组低于开窗组 (8.7±2.8 vs.11.7±2.7)，差异均有统计学意义 (P < 0.05)；术后不同随访时间点两组关节面塌陷程度和 Rasmussen 影像评分差异均无统计学意义；末次随访较术前 Rasmuussen 影像评分增加值截骨组显著高于开窗组 (7.5±3.7 vs.4.8±3.2)，差异有统计学意义 (P < 0.05)。结论 关节面下开窗复位和关节内截骨复位均可有效复位外侧胫骨平台塌陷骨折。开窗复位术后疼痛程度更轻，关节活动范围更大，截骨复位更适宜复位塌陷更明显的骨折。更多还原

【Abstract】 Objective To compare the clinical effect of two reduction methods for lateral tibial plateau depressed fractures.Methods 78 cases of lateral tibial plateau depressed fractures surgically treated in Department of Orthopaedic Trauma,Norhern Jiangsu People’s Hospital,from January 2019 to March 2024 were analyzed retrospectively.According reduction methods all patients were divided into fenestration group and osteotomy group.The general condition,perioperative period,follow-up and imaging measurement data were recorded and compared.Results There were 48 cases in fenestration group and 30 cases in osteotomy group,followed up for 13-71 months (mean 35.0±15.0 months).There were no significant differences in general condition and perioperative indexes between the two groups.There were no significant differences in fracture healing time and Rasmussen function score at each follow-up point between the two groups.2 cases of incision infection occurred in the fenestration group and4 cases of joint stiffness occurred in the osteotomy group.Visual analogue scales (VAS) score of osteotomy group was higher than that of fenestration group at 3 months after operation (2.4±0.6 vs.2.0±0.7),range of motion (ROM)of knee joint extension and flexion in osteotomy group was significantly lower than that of fenestration group at3 months after operation and at the last follow-up[(98.7±17.2) ° vs.(112.1±10.6) °,(122.3±15.9) ° vs.(130.0±9.1) °](P < 0.05).The preoperative articular surface collapse degree in the osteotomy group was higher than that in the fenestration group[(12.0±5.0) mm vs.(8.6±4.7) mm],the preoperative Rasmussen imaging score in the osteotomy group was lower than that in the fenestration group (8.7±2.8 vs.11.7±2.7) (P < 0.05).There was no significant difference in the articular surface collapse degree and Rasmussen imaging score between the two groups at different postoperative follow-up point.The increase of Rasmuussen imaging scores at the last follow-up in the osteotomy group was significantly higher than that in the fenestration group (7.5±3.7 vs.4.8±3.2) (P < 0.05).Conclusions Both subarticular fenestration reduction and intraarticular osteotomy reduction can effectively reduce the depressed fracture of lateral tibial plateau.The pain is lighter and the range of motion is larger after fenestration reduction.Osteotomy group is more suitable for reduction of more severely depressed displacement fracture.更多还原