Watson J T, Coufal C
Department of Orthopaedic Surgery, Wayne State University School of Medicine, Detroit, MI 40201, USA.
Clin Orthop Relat Res. 1998 Aug(353):97-106. doi: 10.1097/00003086-199808000-00012.
Fourteen high energy atypical Schatzker Types I and II fractures were treated using a combination of contemporary internal fixation techniques and Ilizarov methodologies. Fracture were atypical if the primary lateral condylar fracture line extended anteromedially with complete detachment of the tibial tubercle, or posteromedially with extension into the medial or posterior medial tibial condyle, both in association with comminution of the lateral condyle and impaction of the lateral articular surface. Preoperative traction computed tomography scans were used to direct incisions to the area of joint involvement. Fixation included hook plate stabilization of anterior tubercle fragments in five fractures. Adjunctive lateral, medial, or posterior antiglide plates were used where olive wire stabilization was contraindicated because of anatomic constraints. Fractures were neutralized by a three-ring Ilizarov external fixator. At followup, average 19.2 months (range, 8-67 months), all fractures had healed, and 85% had good or excellent knee scores (Knee Society clinical rating scale). Five patients had minor pin tract complications and one patient had a superficial wound slough. This combined approach has shown excellent results for this complex fracture pattern without the severe soft tissue complications associated with internal fixation techniques for high energy fractures.
采用当代内固定技术与伊里扎洛夫方法相结合的方式，治疗了14例高能非典型Schatzker I型和II型骨折。如果主要的外侧髁骨折线向前内侧延伸且胫骨结节完全分离，或者向后内侧延伸并累及内侧或后内侧胫骨髁，同时伴有外侧髁粉碎和外侧关节面撞击，则骨折为非典型骨折。术前牵引计算机断层扫描用于指导切口至关节受累区域。固定包括对5例骨折的前结节碎片采用钩板固定。由于解剖限制，在橄榄丝固定禁忌的情况下，使用辅助的外侧、内侧或后侧防滑钢板。骨折通过三环伊里扎洛夫外固定器进行中和。随访时，平均19.2个月（范围8 - 67个月），所有骨折均愈合，85%的患者膝关节评分良好或优秀（膝关节协会临床评分量表）。5例患者有轻微的针道并发症，1例患者有浅表伤口溃疡。这种联合方法对于这种复杂骨折类型显示出了优异的结果，且没有与高能骨折内固定技术相关的严重软组织并发症。
