CAJ | 학술논문

目的：探讨经改良后侧入路治疗胫骨平台后侧骨折的疗效。方法自2011年7月至2014年4月大连医科大学附属第二医院确诊并收治了胫骨平台后侧骨折21例，其中男13例，女8例；年龄39～55岁（平均45．8岁）；其中17例为单纯后柱骨折，4例合并内侧或外侧柱骨折，单纯后柱骨折中8例患者为后内侧骨折，5例患者为后外侧骨折，4例患者同时累及后内和后外侧。用改良后侧手术入路术式切开复位内固定治疗胫骨平台后侧骨折。本组患者中有4例合并内侧柱或者外侧柱骨折，取“漂浮”体位，采用前内或者前外侧联合入路。采用DeCoster 提出的评价方法对术后即刻复位情况进行评价。采用美国特种医院（ the hospital for special surgery，HSS）膝关节评分标准对术后12个月患膝功能进行分析。结果21例患者手术切口愈合良好；术后即刻X线复查，骨折复位良好。本组患者均获得长时间随访，随访时间12～22（平均16．2）个月。患者10～12周开始部分负重锻炼，骨折愈合后可逐渐完全负重锻炼，骨折愈合时间12～15（平均13）周，无骨延迟愈合、不愈合、内固定失效、关节僵硬，无膝关节内、外翻畸形等并发症。术后12个月复查膝关节的屈伸度平均为5°～130°，根据美国特种医院膝关节评分平均87．2分（65～94分），优良率为90．5％。结论经改良后侧入路治疗胫骨平台后髁骨折操作简单、骨折暴露充分，固定切实可靠，术后可早期功能锻炼，并发症少，临床效果满意。
목적：탐토경개량후측입로치료경골평태후측골절적료효。방법자2011년7월지2014년4월대련의과대학부속제이의원학진병수치료경골평태후측골절21례，기중남13례，녀8례；년령39～55세（평균45．8세）；기중17례위단순후주골절，4례합병내측혹외측주골절，단순후주골절중8례환자위후내측골절，5례환자위후외측골절，4례환자동시루급후내화후외측。용개량후측수술입로술식절개복위내고정치료경골평태후측골절。본조환자중유4례합병내측주혹자외측주골절，취“표부”체위，채용전내혹자전외측연합입로。채용DeCoster 제출적평개방법대술후즉각복위정황진행평개。채용미국특충의원（ the hospital for special surgery，HSS）슬관절평분표준대술후12개월환슬공능진행분석。결과21례환자수술절구유합량호；술후즉각X선복사，골절복위량호。본조환자균획득장시간수방，수방시간12～22（평균16．2）개월。환자10～12주개시부분부중단련，골절유합후가축점완전부중단련，골절유합시간12～15（평균13）주，무골연지유합、불유합、내고정실효、관절강경，무슬관절내、외번기형등병발증。술후12개월복사슬관절적굴신도평균위5°～130°，근거미국특충의원슬관절평분평균87．2분（65～94분），우량솔위90．5％。결론경개량후측입로치료경골평태후과골절조작간단、골절폭로충분，고정절실가고，술후가조기공능단련，병발증소，림상효과만의。
Objective To investigate the effect of modified posterior approach in the treatment of posterior tibial plateau fracture.Methods From July 2011 to April 2014, 21 cases of posterior tibial plateau fracture were diagnosed and treated at the Second Affiliated Hospital of Dalian Medical University, including 17 cases of simple posterior fracture of the tibial plat-eau and 4 cases of posterior fracture of the tibial plateau with lateral column fracture or medial column fracture.There were 8 patients of postermedial tibial plateau fracture, 5 patients of posterolateral tibial plateau fractures, 4 patients involved with both posteromedial fracture and posterolateral fracture.There were 13 males and 8 females with an average age of 45.8 years (range, 39-55 years).The doctors selected the appropriate choice of the modified posterior approach operation technique for the treatment of posterior tibial plateau fracture.There were 4 cases of posterior fracture of the tibial plateau with lateral column fracture or medial column fracture in this group and used the joint operation approach through the"float-ing"posture.Reduction was tested immediately after operation by X-ray according to DeCoster's method.The function of knees was evaluated using HSS score system at 12 months post-operation.Results All wounds achieved healing by first in-tention.X-ray showed that all patients was achieved reduction of anatomy immediately after operation.All patients were followed up 12-23 months (mean,16.2 months).The patient began partial weight-bearing exercise after 10-12 weeks. After fracture healing, the patients could do full weight-bearing exercise gradually.The average fracture healing period was 13 months ( range, 12-15 months) .No related complication occurred, such as nonunion, delayed union, failure in internal fixation, ankylosis, malunion, varus and valgus deformity.The average ROM ( range of motion) of the affected knee joints was 5-130 at 12 mouths postoperatively.The average HSS score was 87.2 (range 65-94, the rate of"excel-lent and good"was 90.5).Conclusion Internal fixation through modified posterior approach for tibial plateau fracture has advantages of less surgery trauma, simple operation, fully exposed, fixed immobilization and received early postoperative rehabilitation.The clinical results are satisfied.