Honkonen S E
Department of Orthopaedics, University Hospital, Tampere, Finland.
Clin Orthop Relat Res. 1994 May(302):199-205.
The residual radioanatomic changes influencing the functional, subjective, and clinical outcome of 131 tibial condyle fractures were studied. Clinical function was found to deteriorate rapidly with increasing values of residual medial tilt of the tibial plateau, whereas lateral tilt of the plateau was well tolerated up to 5 degrees. Articular step-off up to 3 mm and condylar widening up to 5 mm had no adverse effects. Seventy percent of knees with moderate or severe instability were functionally unacceptable. It was concluded that a medial unicondylar fracture with any displacement, and all medially tilted bicondylar fractures, should be operated upon. In fracture of the lateral condyle, open reduction and internal fixation is indicated when lateral tilt or valgus malalignment exceeds 5 degrees, articular step-off exceeds 3 mm, or condylar widening exceeds 5 mm. The same limits apply to laterally tilted bicondylar fractures, provided that the medial condyle is undisplaced. Any displacement seen in the axial bicondylar fracture is an indication for surgical treatment. If there is any mediolateral instability in the extended knee joint after rigid internal fixation, repair of a collateral ligament should be considered. An avulsed anterior cruciate ligament should be fixed, if pathologic laxity exists, but the torn ligament can be ignored and reconstructed later if needed.
研究了影响131例胫骨髁骨折功能、主观感受及临床结果的残留放射解剖学改变。发现随着胫骨平台残留内侧倾斜度增加，临床功能迅速恶化，而平台外侧倾斜度在5度以内时耐受性良好。关节台阶差达3mm及髁部增宽达5mm无不良影响。70%的中度或重度不稳定膝关节功能不可接受。得出结论，任何移位的内侧单髁骨折以及所有内侧倾斜的双髁骨折均应手术治疗。外侧髁骨折时，当外侧倾斜或外翻畸形超过5度、关节台阶差超过3mm或髁部增宽超过5mm时，需行切开复位内固定。对于外侧倾斜的双髁骨折，在内侧髁无移位的情况下适用相同的标准。轴向双髁骨折出现的任何移位均提示需手术治疗。如果在坚强内固定后伸直膝关节存在任何内外侧不稳定，应考虑修复侧副韧带。如果存在病理性松弛，撕脱的前交叉韧带应予以固定，但如果需要，撕裂的韧带可暂不处理，以后再重建。
