中华解剖与临床杂志
中華解剖與臨床雜誌
중화해부여림상잡지
Chinese Journal of Anatomy and Clinics
2015年
5期
435-439
,共5页
宁仁德%姚涛%孔令超%吕飞飞%周业金
寧仁德%姚濤%孔令超%呂飛飛%週業金
저인덕%요도%공령초%려비비%주업금
胫骨骨折%骨折固定术%后髁损伤%三柱分型
脛骨骨摺%骨摺固定術%後髁損傷%三柱分型
경골골절%골절고정술%후과손상%삼주분형
Tibial fractures%Fracture fixation%Posterior condylar injuries%Three columns classification
目的：观察波及后髁的胫骨平台骨折患者在胫骨平台三柱分型理论指导下手术后治疗的效果。方法回顾性分析2011年6月—2013年5月安徽医科大学第三附属医院骨科手术治疗的波及后髁的胫骨平台骨折17例患者的临床资料,其中男12例,女5例；年龄20~54岁,平均33.8岁。其中 SchatzkerⅠ型2例,Ⅲ型3例,Ⅳ型3例,Ⅴ型7例,Ⅵ型2例；单纯后柱骨折4例,后柱+外侧柱骨折4例,后柱+内侧柱骨折2例,后柱+外侧柱+内侧柱骨折7例。单纯胫骨平台后柱骨折或合并内侧柱骨折者,采用膝关节后方倒 L 切口进行暴露及固定；胫骨平台后柱合并外侧柱骨折以及后柱同时合并外侧柱和内侧柱骨折者,采用膝关节后方倒 L 切口联合膝关节前外侧切口进行暴露及固定。术后膝关节 X 线片检查并测量胫骨平台的内翻角及后倾角,并以膝关节 Rasmussen 功能评分方法对术后疗效进行评估。结果本组17例患者均获得1年以上随访,骨折均一期愈合,无一例感染、皮肤坏死及内固定松动、断裂等。患者术后即刻胫骨平台内翻角平均为86.27°±0.35°、术后1年平均为86.39°±0.32°(t =0.940),术后即刻胫骨平台后倾角平均为9.15°±0.34°、术后1年平均为9.17°±0.34°(t =0.687),差异均无统计学意义(P 值均>0.05)。术后1年患者膝关节Rasmussen 功能评分总优良率16/17。结论胫骨平台骨折三柱分型理论对波及后髁的胫骨平台骨折手术术式的选择有指导意义,单纯膝关节后方倒 L 切口或辅以膝关节前外侧切口能够对绝大部分波及后髁的胫骨平台骨折进行很好地暴露及固定,术后疗效满意。
目的：觀察波及後髁的脛骨平檯骨摺患者在脛骨平檯三柱分型理論指導下手術後治療的效果。方法迴顧性分析2011年6月—2013年5月安徽醫科大學第三附屬醫院骨科手術治療的波及後髁的脛骨平檯骨摺17例患者的臨床資料,其中男12例,女5例；年齡20~54歲,平均33.8歲。其中 SchatzkerⅠ型2例,Ⅲ型3例,Ⅳ型3例,Ⅴ型7例,Ⅵ型2例；單純後柱骨摺4例,後柱+外側柱骨摺4例,後柱+內側柱骨摺2例,後柱+外側柱+內側柱骨摺7例。單純脛骨平檯後柱骨摺或閤併內側柱骨摺者,採用膝關節後方倒 L 切口進行暴露及固定；脛骨平檯後柱閤併外側柱骨摺以及後柱同時閤併外側柱和內側柱骨摺者,採用膝關節後方倒 L 切口聯閤膝關節前外側切口進行暴露及固定。術後膝關節 X 線片檢查併測量脛骨平檯的內翻角及後傾角,併以膝關節 Rasmussen 功能評分方法對術後療效進行評估。結果本組17例患者均穫得1年以上隨訪,骨摺均一期愈閤,無一例感染、皮膚壞死及內固定鬆動、斷裂等。患者術後即刻脛骨平檯內翻角平均為86.27°±0.35°、術後1年平均為86.39°±0.32°(t =0.940),術後即刻脛骨平檯後傾角平均為9.15°±0.34°、術後1年平均為9.17°±0.34°(t =0.687),差異均無統計學意義(P 值均>0.05)。術後1年患者膝關節Rasmussen 功能評分總優良率16/17。結論脛骨平檯骨摺三柱分型理論對波及後髁的脛骨平檯骨摺手術術式的選擇有指導意義,單純膝關節後方倒 L 切口或輔以膝關節前外側切口能夠對絕大部分波及後髁的脛骨平檯骨摺進行很好地暴露及固定,術後療效滿意。
목적：관찰파급후과적경골평태골절환자재경골평태삼주분형이론지도하수술후치료적효과。방법회고성분석2011년6월—2013년5월안휘의과대학제삼부속의원골과수술치료적파급후과적경골평태골절17례환자적림상자료,기중남12례,녀5례；년령20~54세,평균33.8세。기중 SchatzkerⅠ형2례,Ⅲ형3례,Ⅳ형3례,Ⅴ형7례,Ⅵ형2례；단순후주골절4례,후주+외측주골절4례,후주+내측주골절2례,후주+외측주+내측주골절7례。단순경골평태후주골절혹합병내측주골절자,채용슬관절후방도 L 절구진행폭로급고정；경골평태후주합병외측주골절이급후주동시합병외측주화내측주골절자,채용슬관절후방도 L 절구연합슬관절전외측절구진행폭로급고정。술후슬관절 X 선편검사병측량경골평태적내번각급후경각,병이슬관절 Rasmussen 공능평분방법대술후료효진행평고。결과본조17례환자균획득1년이상수방,골절균일기유합,무일례감염、피부배사급내고정송동、단렬등。환자술후즉각경골평태내번각평균위86.27°±0.35°、술후1년평균위86.39°±0.32°(t =0.940),술후즉각경골평태후경각평균위9.15°±0.34°、술후1년평균위9.17°±0.34°(t =0.687),차이균무통계학의의(P 치균>0.05)。술후1년환자슬관절Rasmussen 공능평분총우량솔16/17。결론경골평태골절삼주분형이론대파급후과적경골평태골절수술술식적선택유지도의의,단순슬관절후방도 L 절구혹보이슬관절전외측절구능구대절대부분파급후과적경골평태골절진행흔호지폭로급고정,술후료효만의。
Objective To investigate surgical outcome of tibial plateau fracture involved the posterior condylar which was guided by three columns theory of tibial plateau fracture. Methods Seventeen patients with tibial plateau fractures involved the posterior condylar treated in the Third Affiliated Hospital of Anhui Medical University from June 2011 to May 2013 were analyzed retrospectively, in which male 12 patients, female 5 patients, age 20 - 54 years old, average 33. 8 years old; Schatzker fracture classification: Ⅰtype 2 patients, Ⅲ type 3 patients, Ⅳ type 3 patients, Ⅴ type 7 patients, Ⅵ type 2 patients, three columns fracture classification: Simple posterior column fracture 4 patients, posterior column fracture combined lateral column 4 cases, posterior column fracture combined medial column 2 patients, posterior column fracture combined lateral column and medial column fracture 7 patients. The " L"incision behind the knee joint was used for simple posterior column fracture or combined medial column fracture of tibial plateau, while the " L" incision and anterolateral incision of the knee joint were used for posterior column fracture combined lateral column or combined lateral and medial column fracture of tibial plateau. Knee X-ray was examined and the varus angle and posterior slope of tibial plateau were measured postoperatively, while knee Rasmussen function score was assessed postoperatively. Results Seventeen patients were received more than 1 year follow-up, all tibial plateau fractures were healed, in which there were no complication of infection, skin necrosis, loosening and breakage of internal fixation. The mean varus angle of tibial plateau in patients was 86. 27° ± 0. 35° postoperatively, and it was 86. 39° ± 0. 32° at 1 year after operation(t = 0. 940). The mean posterior slope of tibial plateau was 9. 15° ± 0. 34° postoperatively, and it was 9. 17° ± 0. 34° at 1 year after operation(t = 0. 687). There were no significant differences in the varus angle and posterior slope of tibial plateau between 1 year after operation and immediate postoperative (all P values > 0. 05). The total fine rate of 17 patients in knee Rasmussen function score was 16 / 17 at 1 year after operation. Conclusions Three column theory of tibial plateau fracture is a fine guidance in the surgical treatment to tibial plateau fractures involved the posterior condylar, the " L" incision behind the knee joint or combined the auxiliary anterolateral incisions of the knee joint have the good exposure and corresponding fixation to the most tibia platfeau fracture involved the posterior condylar.
