CAJ | 학술논문

目的探讨膝关节后内侧入路和后外侧入路手术治疗胫骨平台后侧骨折的手术方法和临床疗效.方法 2006年1月至2008年6月,采用后侧入路手术治疗胫骨平台后侧骨折获得随访的患者21例,男12例,女9例;年龄28～68岁,平均39.5岁.致伤原因:车祸伤13例,高处坠落伤8例.按Khan骨折分型:后内侧骨折7例,后外侧骨折8例,同时累及后内及后外侧骨折6例;均为新鲜闭合性骨折.采用胫骨平台后内侧入路7例,胫骨平台后外侧入路8例,后内外联合人路6例.结果 21例患者均获得随访,随访时间12～24个月,平均16.2个月.无一例发生切口感染、血管神经损伤、内固定松动及断裂,骨折均愈合,无膝关节内、外翻畸形和骨折再移位.术后Rasmussen膝关节功能为13～30分,平均24.2分,其中优12例,良7例,可2例,优良率为90.5%;Rasmussen放射学评分为10～18分,平均15.6分,其中优13例,良7例,可1例,优良率为95.2%.术后1例膝关节伸屈活动明显受限,经二期关节镜下松解并行功能锻炼后改善;2例发生创伤性关节炎,经向关节内注射玻璃酸钠及口服非甾体类抗炎药物后疼痛缓解.结论膝关节后内侧和后外侧入路手术治疗胫骨平台后侧骨折,有利于平台后侧骨折的复位和固定,具有暴露清楚、内固定安放方便、创伤小及临床疗效好等优点.运用合适的内固定和恰当的功能锻炼可取得满意的临床疗效.
목적 탐토슬관절후내측입로화후외측입로수술치료경골평태후측골절적수술방법화림상료효.방법 2006년1월지2008년6월,채용후측입로수술치료경골평태후측골절획득수방적환자21례,남12례,녀9례;년령28～68세,평균39.5세.치상원인:차화상13례,고처추락상8례.안Khan골절분형:후내측골절7례,후외측골절8례,동시루급후내급후외측골절6례;균위신선폐합성골절.채용경골평태후내측입로7례,경골평태후외측입로8례,후내외연합인로6례.결과 21례환자균획득수방,수방시간12～24개월,평균16.2개월.무일례발생절구감염、혈관신경손상、내고정송동급단렬,골절균유합,무슬관절내、외번기형화골절재이위.술후Rasmussen슬관절공능위13～30분,평균24.2분,기중우12례,량7례,가2례,우량솔위90.5%;Rasmussen방사학평분위10～18분,평균15.6분,기중우13례,량7례,가1례,우량솔위95.2%.술후1례슬관절신굴활동명현수한,경이기관절경하송해병행공능단련후개선;2례발생창상성관절염,경향관절내주사파리산납급구복비치체류항염약물후동통완해.결론 슬관절후내측화후외측입로수술치료경골평태후측골절,유리우평태후측골절적복위화고정,구유폭로청초、내고정안방방편、창상소급림상료효호등우점.운용합괄적내고정화흡당적공능단련가취득만의적림상료효.
Objective To discuss the operative procedures and clinical result of posteromedial and posterolateral approaches in treatment of posterior condylar tibial plateau fractures. Methods From January 2006 to June 2008, 21 patients of posterior condylar tibial plateau fractures were treated by posteromedial and posterolateral knee approaches. There were 12 males and 9 females. The age ranged from 28 to 68 years, with a mean of 39.5 years. Of the patients, 13 had resulted from a traffic accident and 8 had caused by a fall. As for the state of posterior condylar tibial plateau fractures, 7 patients had a medial condylar.fracture, 8 patients had a lateral condylar fracture and 6 patients had a bilateral condylar fracture. Results A follow-up lasted 12-24 months (mean 16.2 months ) in 21 patients. There was no infection, no varus or valgus of the knee, no nerve injuries and loosening or breakage of the screw. All cases had attained bone union. According to the Rasmussen functional scoring, the results were excellent in 12, good in 7 and fair in 2. The excellent and good rate of clinical results was 90.5%. Radiologic results were graded with the Rasmussen score to evaluate the reduction of fracture. There were excellent in 13, good in 7 and fair in 1. The excellent and good rate of clinical results was 95.2%. Conclusion Posteromedial and posterolateral approaches can facilitate the reduction and fixation for posterior condylar tibial plateau fractures. It has many advantages such as good exposure, less invasion and the excellent clinical results.