CAJ | 학술논문

目的介绍胫骨远端后柱骨折的概念、解剖、分型,探讨后侧入路支撑钢板固定治疗胫骨远端Ⅲ型后柱骨折的临床疗效. 方法胫骨远端关节面近似梯形,将其前后分成两部分,前1/2较宽称为前柱,后1/2较窄称为后柱.包括原始的后踝以及胫骨远端后侧干骺,骨折线由后上斜向后下的波及远端关节面≤50%的胫骨远端骨折称为后柱骨折.根据其解剖特点结合CT平扫加三维重建将后柱骨折分为三型:Ⅰ型:后穹隆骨折,骨折线不超过后穹隆骨折,骨块<后柱的1/4;Ⅱ型:1/4<骨块≤1/2;Ⅲ型:骨块>后柱的1/2.自2005年3月至2008年9月共收治胫骨远端后柱骨折95例,其中27例Ⅲ型后柱骨折经后侧入路支撑钢板固定并获得随访. 结果 27例患者获得12～50个月(平均35.7个月)随访.骨折全部愈合,时间10.0～13.5周(平均11.3周),完全负重时间11.0～14.3周(平均12.1周).根据美国足踝外科协会(AOFAS)踝关节功能评分系统对术后1年的踝关节功能进行评分:平均(97±3)分,其中优19例,良7例,一般1例,优良率为96.3%.术后1例患者出现伤口浅表感染,经保守治疗痊愈.无螺钉松动、断裂及内同定失效以及腓肠肌挛缩等并发症. 结论胫骨远端后柱骨折的概念及分型理念为胫骨远端后侧骨折的治疗提供新的指导方式,经后侧入路支撑钢板固定是治疗胫骨远端Ⅲ型后柱骨折的一种有效方法 ,但要熟悉胫骨远端后侧解剖结构、正确掌握手术适应证.
목적 개소경골원단후주골절적개념、해부、분형,탐토후측입로지탱강판고정치료경골원단Ⅲ형후주골절적림상료효. 방법 경골원단관절면근사제형,장기전후분성량부분,전1/2교관칭위전주,후1/2교착칭위후주.포괄원시적후과이급경골원단후측간후,골절선유후상사향후하적파급원단관절면≤50%적경골원단골절칭위후주골절.근거기해부특점결합CT평소가삼유중건장후주골절분위삼형:Ⅰ형:후궁륭골절,골절선불초과후궁륭골절,골괴<후주적1/4;Ⅱ형:1/4<골괴≤1/2;Ⅲ형:골괴>후주적1/2.자2005년3월지2008년9월공수치경골원단후주골절95례,기중27례Ⅲ형후주골절경후측입로지탱강판고정병획득수방. 결과 27례환자획득12～50개월(평균35.7개월)수방.골절전부유합,시간10.0～13.5주(평균11.3주),완전부중시간11.0～14.3주(평균12.1주).근거미국족과외과협회(AOFAS)과관절공능평분계통대술후1년적과관절공능진행평분:평균(97±3)분,기중우19례,량7례,일반1례,우량솔위96.3%.술후1례환자출현상구천표감염,경보수치료전유.무라정송동、단렬급내동정실효이급비장기련축등병발증. 결론 경골원단후주골절적개념급분형이념위경골원단후측골절적치료제공신적지도방식,경후측입로지탱강판고정시치료경골원단Ⅲ형후주골절적일충유효방법 ,단요숙실경골원단후측해부결구、정학장악수술괄응증.
Objective To investigate the treatment of type Ⅲ fractures of posterior column of the distal tibia using buttress plating via a modified posterior approach. Methods From March 2005 to September 2008, 95 patients were admitted to our department for posterior column fractures of the distal tibia. Of them, 31 were of type Ⅲ and treated by buttress plating via a modified posterior approach. Bone graft with autoallergic ilium or artificial bone was conducted for those complicated with bone defects. Results Only 27 of the 31 patients were available for the follow-up of 12 to 50 (average, 35.7) months. Their fractures healed at 11.3 (10.0 to 13.5) weeks after the operation. The time of complete weight loading averaged 12.1 (11.0 to 14.3) weeks. According to the American Orthopaedic Foot & Ankle Society(AOFAS) scoring sys-tem, 20 cases were rated as excellent and 7 as good 12 months after operation. The average AOFAS score was 97±3. Postoperatively, 1 case had a superficial infection of the wound which responded to conservative treat-ment. No loosening or breaking of the screws or failure of the internal fixation happened. Conclusion Buttress plating via a modified posterior approach is an effective method for type Ⅲ fractures of posterior column of the distal tibia, as long as surgeons have a good command of the anatomy of the posterior aspect of the distal tibia and the indications of the plating.