CAJ | 학술논문

目的探讨外侧扩大切口入路治疗胫骨平台后侧及外侧粉碎性骨折临床疗效. 方法回顾性分析2010年8月至2012年3月收治的16例胫骨平台后侧及外侧粉碎性骨折患者资料,男12例,女4例;年龄21 ～ 66岁,平均37.9岁;左侧5例,右侧11例;均为闭合性骨折.骨折根据CT三柱分型均为波及后侧柱和外侧柱的塌陷骨折;骨折按Schatzker分型:Ⅱ型9例,V型6例,Ⅵ型1例;骨折按AO/OTA分型:B3型9例,C1型6例,C2型1例.手术均采用侧卧漂浮体位、膝外侧扩大切口入路,自腘横纹内侧向外侧再经腓骨小头上方弧形向下至胫骨结节内侧,切口长12 ～ 15 cm,经肌肉间隙显露胫骨整个外侧平台,直视下复位骨折并植骨内固定. 结果 16例患者均顺利完成手术,手术时间为52 ～110 min(平均71.0 min);术后获6～18个月(平均13.0个月)随访.无血管、神经损伤及伤口感染等并发症发生;骨折均获骨性愈合,平均愈合时间为12周(10 ～14周),无骨折再塌陷及膝内、外翻畸形发生.末次随访时根据Rasmussen膝关节功能评分标准评定疗效:优10例,良4例,可2例. 结论经膝外侧扩大切口入路治疗胫骨平台后侧及外侧粉碎性骨折,可于侧卧位实施手术,单一切口能较好地显露胫骨前外侧、后外侧、后内侧平台及腓骨小头,可直视下复位骨折并植骨内固定,手术损伤小、时间短且并发症少.
목적 탐토외측확대절구입로치료경골평태후측급외측분쇄성골절림상료효. 방법 회고성분석2010년8월지2012년3월수치적16례경골평태후측급외측분쇄성골절환자자료,남12례,녀4례;년령21 ～ 66세,평균37.9세;좌측5례,우측11례;균위폐합성골절.골절근거CT삼주분형균위파급후측주화외측주적탑함골절;골절안Schatzker분형:Ⅱ형9례,V형6례,Ⅵ형1례;골절안AO/OTA분형:B3형9례,C1형6례,C2형1례.수술균채용측와표부체위、슬외측확대절구입로,자객횡문내측향외측재경비골소두상방호형향하지경골결절내측,절구장12 ～ 15 cm,경기육간극현로경골정개외측평태,직시하복위골절병식골내고정. 결과 16례환자균순리완성수술,수술시간위52 ～110 min(평균71.0 min);술후획6～18개월(평균13.0개월)수방.무혈관、신경손상급상구감염등병발증발생;골절균획골성유합,평균유합시간위12주(10 ～14주),무골절재탑함급슬내、외번기형발생.말차수방시근거Rasmussen슬관절공능평분표준평정료효:우10례,량4례,가2례. 결론 경슬외측확대절구입로치료경골평태후측급외측분쇄성골절,가우측와위실시수술,단일절구능교호지현로경골전외측、후외측、후내측평태급비골소두,가직시하복위골절병식골내고정,수술손상소、시간단차병발증소.
Objective To explore the surgical approach for internal fixation of comminuted posterior/lateral condylar fractures of tibial plateau.Methods Sixteen consecutive patients with comminuted posterior/lateral condylar fractures of tibial plateau were admitted to our department from August 2010 to March 2012.They were 12 males and 4 females,with an average age of 37.9 years (from 21 to 66 years).All cases were closed fractures,involving 5 left sides and 11 right sides.They were all collapsed fractures involving posterior/lateral column according to the Three-Column classification based on CT scans.By the Schatzker classification,9 cases were type Ⅱ,6 type V and one type VI; by the AO/OTA classification,9 cases were type B3,6 C1 and one type C2.Internal fixation was performed via expanded lateral incision when the patient was side lying.The incision was 12 cm long,starting from the medial to the lateral popliteal crease and then running above the fibular capitellum to the medial tubercle of tibia,to expose the whole lateral condyle of the tibial plateau in the intermuscular space.Results All the 16 patients were successfully operated on in a mean time of 71.0 min (from 52 to 110 min).The follow-ups lasted from 6 to 18 months (average,13.0 months),revealing no neurovascular complications or wound infection.All obtained bony union after a mean time of 12 weeks (from 10 to 14 weeks).No secondary collapse of tibial plateau or knee varus/valgus occurred.The postoperative knee function was excellent in 10 cases,good in 4 and fair in 2,according to the Rasmussen's scoring system.Conclusions The expanded lateral incision can expose well the anterolateral,posterolateral and medial-posterior aspects of the tibial plateau and the capitellum to facilitate reduction and internal fixation when the patient lies in a lateral position.These will lead to limited invasion,less operative time and fine outcomes in the treatment of comminuted posterior/lateral condylar fractures of tibial plateau.