CAJ | 학술논문

目的探讨累及后柱的胫骨平台骨折的手术方法及其近期疗效.方法回顾性分析2009年3月至2012年1月手术治疗的累及后柱的胫骨平台骨折32例,男21例,女11例;年龄23～60岁,平均40.4岁.闭合性骨折30例,开放性骨折2例.合并前十字韧带止点撕脱骨折2例、后十字韧带止点撕脱骨折3例.后外侧柱伴内侧柱骨折6例,采用后外侧+前内侧入路;后内侧柱伴内侧柱、外侧柱骨折7例,采用后内侧+前外侧入路(其中2例辅以前内侧小切口);后内侧柱伴外侧柱骨折11例,采有后内侧+前外侧入路;后内侧柱伴后外侧柱骨折3例,采用后内侧+后外侧入路2例、单纯后内侧入路1例;后内侧柱、后外侧柱伴外侧柱骨折5例,采用后内侧+前外侧入路3例及后内侧、后外侧+前外侧入路2例.行骨折复位钢板固定.结果 32例获得随访,随访时间5～24个月,平均10.7个月.骨折临床愈合时间平均为15.9周,完全负重时间平均为18.1周.术后3个月膝关节活动度平均为113.3°;美国特种外科医院(the Hospital for Special Surgery,HSS)膝关节评分优22例、良6例、可3例、差1例,优良率87.5％(28/32).结论对累及后柱的胫骨平台骨折,经膝关节后内侧、后外侧入路可获得满意的复位效果,钢板固定可有效重建胫骨平台后柱的稳定性,允许早期功能锻炼,并发症少,近期疗效满意.
목적 탐토루급후주적경골평태골절적수술방법급기근기료효.방법 회고성분석2009년3월지2012년1월수술치료적루급후주적경골평태골절32례,남21례,녀11례;년령23～60세,평균40.4세.폐합성골절30례,개방성골절2례.합병전십자인대지점시탈골절2례、후십자인대지점시탈골절3례.후외측주반내측주골절6례,채용후외측+전내측입로;후내측주반내측주、외측주골절7례,채용후내측+전외측입로(기중2례보이전내측소절구);후내측주반외측주골절11례,채유후내측+전외측입로;후내측주반후외측주골절3례,채용후내측+후외측입로2례、단순후내측입로1례;후내측주、후외측주반외측주골절5례,채용후내측+전외측입로3례급후내측、후외측+전외측입로2례.행골절복위강판고정.결과 32례획득수방,수방시간5～24개월,평균10.7개월.골절림상유합시간평균위15.9주,완전부중시간평균위18.1주.술후3개월슬관절활동도평균위113.3°;미국특충외과의원(the Hospital for Special Surgery,HSS)슬관절평분우22례、량6례、가3례、차1례,우량솔87.5％(28/32).결론 대루급후주적경골평태골절,경슬관절후내측、후외측입로가획득만의적복위효과,강판고정가유효중건경골평태후주적은정성,윤허조기공능단련,병발증소,근기료효만의.
Objective To investigate surgical techniques for tibial plateau fractures involving the posterior column and the corresponding clinical effect.Methods From March 2009 to January 2012,32 patients with tibial plateau fracture involving the posterior column underwent surgical treatment in our hospital,including 21 males and 11 females,aged from 23 to 60 years (average,40.4 years).There were 30 cases of closed fracture and 2 cases of open fracture.Two patients combined with anterior cruciate ligament avulsion fracture,and 3 patients with posterior cruciate ligament avulsion fracture.Posterolateral and anteromedial approaches were used in 6 patients with posterolateral and medial columns fracture.Posteromedial and anterolateral approaches were used in 7 patients with posteromedial,medial and lateral columns fracture; a small anteromedial incision was added in 2 of them.Posteromedial and anterolateral approaches were used in 11 patients with posteromedial and lateral columns fracture.Posteromedial and posterolateral approaches were used in 2 patients with posteromedial and posterolateral columns fracture,while a single posteromedial approach was used in another patient with same fracture.Posteromedial and anterolateral approaches were used in 3 patients with posteromedial,posterolateral and lateral columns fracture,while posterolateral and anterolateral approaches were used in other 2 patients with same fracture.Results All patients obtained satisfactory exposure and reduction.They were followed up for 5 to 24 months (average,10.7 months).The average bone union time was 15.9 weeks,and the average time from operation to full weight-bearing was 18.1 weeks.The average range of motion of knee was 113.3°.According to HSS (Hospital for Special Surgery) score,the results were excellent in 22 cases,good in 6 cases,fair in 3 cases and bad in 1 case; the total excellent and good rate was 87.5％.Conclusion For tibial plateau fractures involving posterior column,satisfactory reduction and fixation can be obtained via posteromedial and posterolateral approaches which have many advantages such as earlier functional exercise,fewer complications and excellent clinical results.