中华创伤骨科杂志
中華創傷骨科雜誌
중화창상골과잡지
CHINESE JOURNAL OF ORTHOPAEDIC TRAUMA
2013年
2期
128-131
,共4页
胫骨骨折%骨折固定术,内%治疗结果%手术入路
脛骨骨摺%骨摺固定術,內%治療結果%手術入路
경골골절%골절고정술,내%치료결과%수술입로
Tibial fractures%Fracture fixation,internal%Treatment outcome%Approach
目的 探讨前外侧加后内侧入路治疗复杂胫骨平台骨折的疗效. 方法 回顾性分析2008年1月至2011年12月收治且获得随访的68例SchatzkerⅤ、Ⅵ型胫骨平台骨折患者资料,男42例,女26例；年龄22～64岁,平均42.3岁；左侧24例,右侧44例.受伤至手术时间为3～15 d,平均7.4d.所有患者胫骨平台骨折均采用前外侧加后内侧入路,外侧采用T型或L型钢板、后内侧采用重建钢板或桡骨远端T型钢板固定治疗.末次随访时按照美国特种外科医院膝关节功能评分法评定疗效. 结果 本组患者手术时间平均为3.13h,术中出血量平均为526.7 mL,住院时间平均为20.4d.68例患者术后获12 ～ 38个月(平均18.8个月)随访.骨折愈合时间为4～8个月,平均6.7个月.68例患者术后即刻胫骨平台内翻角、后倾角、股胫角平均分别为87.3°±1.5°、12.0°±2.5°、170.0°±2.5°,术后1年平均分别为86.8°±1.2°、13.0°±1.8°、171.0°±1.7°,以上项目术后即刻与术后1年比较差异均无统计学意义(P＞0.05).末次随访时按照美国特种外科医院膝关节功能评分法评定疗效:优36例,良24例,中6例,差2例,优良率为88.2％.本组患者无神经及血管损伤、深部感染、内固定物松动或裂断等并发症发生. 结论 采用前外侧加后内侧入路治疗复杂胫骨平台骨折可达到解剖复位、坚强固定及早期进行功能锻炼的目的,效果满意.
目的 探討前外側加後內側入路治療複雜脛骨平檯骨摺的療效. 方法 迴顧性分析2008年1月至2011年12月收治且穫得隨訪的68例SchatzkerⅤ、Ⅵ型脛骨平檯骨摺患者資料,男42例,女26例；年齡22～64歲,平均42.3歲；左側24例,右側44例.受傷至手術時間為3～15 d,平均7.4d.所有患者脛骨平檯骨摺均採用前外側加後內側入路,外側採用T型或L型鋼闆、後內側採用重建鋼闆或橈骨遠耑T型鋼闆固定治療.末次隨訪時按照美國特種外科醫院膝關節功能評分法評定療效. 結果 本組患者手術時間平均為3.13h,術中齣血量平均為526.7 mL,住院時間平均為20.4d.68例患者術後穫12 ～ 38箇月(平均18.8箇月)隨訪.骨摺愈閤時間為4～8箇月,平均6.7箇月.68例患者術後即刻脛骨平檯內翻角、後傾角、股脛角平均分彆為87.3°±1.5°、12.0°±2.5°、170.0°±2.5°,術後1年平均分彆為86.8°±1.2°、13.0°±1.8°、171.0°±1.7°,以上項目術後即刻與術後1年比較差異均無統計學意義(P＞0.05).末次隨訪時按照美國特種外科醫院膝關節功能評分法評定療效:優36例,良24例,中6例,差2例,優良率為88.2％.本組患者無神經及血管損傷、深部感染、內固定物鬆動或裂斷等併髮癥髮生. 結論 採用前外側加後內側入路治療複雜脛骨平檯骨摺可達到解剖複位、堅彊固定及早期進行功能鍛煉的目的,效果滿意.
목적 탐토전외측가후내측입로치료복잡경골평태골절적료효. 방법 회고성분석2008년1월지2011년12월수치차획득수방적68례SchatzkerⅤ、Ⅵ형경골평태골절환자자료,남42례,녀26례；년령22～64세,평균42.3세；좌측24례,우측44례.수상지수술시간위3～15 d,평균7.4d.소유환자경골평태골절균채용전외측가후내측입로,외측채용T형혹L형강판、후내측채용중건강판혹뇨골원단T형강판고정치료.말차수방시안조미국특충외과의원슬관절공능평분법평정료효. 결과 본조환자수술시간평균위3.13h,술중출혈량평균위526.7 mL,주원시간평균위20.4d.68례환자술후획12 ～ 38개월(평균18.8개월)수방.골절유합시간위4～8개월,평균6.7개월.68례환자술후즉각경골평태내번각、후경각、고경각평균분별위87.3°±1.5°、12.0°±2.5°、170.0°±2.5°,술후1년평균분별위86.8°±1.2°、13.0°±1.8°、171.0°±1.7°,이상항목술후즉각여술후1년비교차이균무통계학의의(P＞0.05).말차수방시안조미국특충외과의원슬관절공능평분법평정료효:우36례,량24례,중6례,차2례,우량솔위88.2％.본조환자무신경급혈관손상、심부감염、내고정물송동혹렬단등병발증발생. 결론 채용전외측가후내측입로치료복잡경골평태골절가체도해부복위、견강고정급조기진행공능단련적목적,효과만의.
Objective To investigate surgical outcomes of anterolateral plus posteromedial approaches for treatment of complex tibial plateau fractures.Methods We reviewed 68 patients with tibial plateau fractures of Schatzker types Ⅴ and Ⅵ who had been treated from January 2008 to December 2011 and fully followed up in our department.They were 42 men and 26 women,22 to 64 years of age (average,42.3 years).Fractures occurred at the left side in 24 cases and at the right side in 44 cases.Intervals between injury and operation ranged from 3 to 15 days,7.4 days on average.All of them were operated on through anterolateral plus posteromedial approaches.T-or L-shaped steel plates were used laterally while reconstruction plates or T-shaped plates for distal radius were used medially.Results In this cohort the operation time averaged 3.13 hours,intraoperative blood loss 562.7 mL and hospital stay 20.4 days.All cases were followed up for an average of 18.8 months (range,12 to 38 months).Fractures healed from 4 to 8 months,6.7 months on average.The average tibial plateau angle,posterior slope angle and femorotibial angle immediately postoperation were respectively 87.3°± 1.5°,12.0°± 2.5° and 170.0°± 2.5°,not significantly different from those at one year postoperation (86.8° ± 1.2°,13.0° ± 1.8° and 171.0° ± 1.7°) (P ＞ 0.05).According to The Hospital for Special Surgery Score,the outcomes were excellent in 36 cases,good in 24 cases,fair in 6 cases and poor in 2 cases,with a good to excellent rate of 88.2％.No neural or vascular injury,deep infection,or implant failure was found in this group.Conclusion Anterolateral plus posteromedial approaches are effective for complex tibial plateau fractures,leading to anatomic reduction,stable fixation and early functional rehabilitation.
