中国实用医药
中國實用醫藥
중국실용의약
CHINA PRACTICAL MEDICAL
2014年
30期
12-13,14
,共3页
胫骨骨折%翻转体位%手术入路
脛骨骨摺%翻轉體位%手術入路
경골골절%번전체위%수술입로
Tibial fractures%Flipping supine position%Operative approach
目的：探讨翻转体位前后联合入路治疗复杂胫骨平台骨折的手术体位、手术入路、手术方法和临床疗效。方法回顾性分析采用翻转体位前后联合入路治疗且随访完整的15例复杂胫骨平台骨折患者的临床资料。均采用翻转体位后内侧倒“L”形入路联合前外侧入路行钢板螺钉内固定，关节面塌陷者采用同种异体骨或自体髂骨植骨术。结果所有患者获得随访，随访时间8~24个月，平均随访16.3个月，全部病例获得影像学上的骨性愈合，愈合时间l6~26周，平均愈合时间20周。术中未出现血管、神经损伤，术后无内固定松动及断裂，术后1例出现浅表伤口感染。术后末次随访Rasmussen膝关节功能评分为15~28分，平均24.3分，其中优6例，良7例，可2例，优良率86.7%。术后末次随访Rasmussen放射学评分12~18分，平均评分16.7分，其中优9例，良5例，可1例，优良率93.3%。结论对于涉及后方平台的复杂胫骨平台三柱骨折，翻转体位前后侧联合入路可以很好地暴露骨折块，复位良好，并发症少，近期取得满意疗效。
目的：探討翻轉體位前後聯閤入路治療複雜脛骨平檯骨摺的手術體位、手術入路、手術方法和臨床療效。方法迴顧性分析採用翻轉體位前後聯閤入路治療且隨訪完整的15例複雜脛骨平檯骨摺患者的臨床資料。均採用翻轉體位後內側倒“L”形入路聯閤前外側入路行鋼闆螺釘內固定，關節麵塌陷者採用同種異體骨或自體髂骨植骨術。結果所有患者穫得隨訪，隨訪時間8~24箇月，平均隨訪16.3箇月，全部病例穫得影像學上的骨性愈閤，愈閤時間l6~26週，平均愈閤時間20週。術中未齣現血管、神經損傷，術後無內固定鬆動及斷裂，術後1例齣現淺錶傷口感染。術後末次隨訪Rasmussen膝關節功能評分為15~28分，平均24.3分，其中優6例，良7例，可2例，優良率86.7%。術後末次隨訪Rasmussen放射學評分12~18分，平均評分16.7分，其中優9例，良5例，可1例，優良率93.3%。結論對于涉及後方平檯的複雜脛骨平檯三柱骨摺，翻轉體位前後側聯閤入路可以很好地暴露骨摺塊，複位良好，併髮癥少，近期取得滿意療效。
목적：탐토번전체위전후연합입로치료복잡경골평태골절적수술체위、수술입로、수술방법화림상료효。방법회고성분석채용번전체위전후연합입로치료차수방완정적15례복잡경골평태골절환자적림상자료。균채용번전체위후내측도“L”형입로연합전외측입로행강판라정내고정，관절면탑함자채용동충이체골혹자체가골식골술。결과소유환자획득수방，수방시간8~24개월，평균수방16.3개월，전부병례획득영상학상적골성유합，유합시간l6~26주，평균유합시간20주。술중미출현혈관、신경손상，술후무내고정송동급단렬，술후1례출현천표상구감염。술후말차수방Rasmussen슬관절공능평분위15~28분，평균24.3분，기중우6례，량7례，가2례，우량솔86.7%。술후말차수방Rasmussen방사학평분12~18분，평균평분16.7분，기중우9례，량5례，가1례，우량솔93.3%。결론대우섭급후방평태적복잡경골평태삼주골절，번전체위전후측연합입로가이흔호지폭로골절괴，복위량호，병발증소，근기취득만의료효。
Objective To investigate the operative position, operative approach, operative method and clinical effect of posteromedial and anterolateral approaches in flipping supine position in the treatment of complex tibial plateau fractures. Methods The clinical data of 15 cases of complex tibial plateau fracture, which underwent the treatment of posteromedial and anterolateral approaches in flipping supine position with completed follow-up, were retrospectively analyzed. All cases were treated by posteromedial converse“L”approach and anterolateral approach in flipping supine position with steel screw internal fixation. Allograft bone or autogenous iliac bone transplantation were conducted for articular surface collapse. Results All the cases were followed up for 8 to 24 months, and the average time were 16.3 months. All cases had imaging bone union with the healing time ranged from 16 to 26 weeks, and the average time was 20 weeks. There were no intraoperative blood vessel or nerve injuries and postoperative internal fixation loosening or breakage occurred, while 1 case of postoperative superficial wound infection appeared. Rasmussen knee function score in the last follow-up was 15~28 points with an average score as 24.3 points, and there were 6 excellent cases, 7 good cases and 2 fair cases with the good rate as 86.7%. Postoperative Rasmussen radiologic score in the last follow-up was 12~18 points with an average score as 16.7 points. There were 9 excellent cases, 5 good cases and 1 fair case with the good rate as 93.3%. Conclusion Posteromedial and anterolateral approaches in flipping supine position of treating complex tibial plateau fractures can expose the fractures block with good fixation and less complication, and its short-term effect is satisfying.
