摘要
目的介绍一种基于CT的胫骨平台骨折的三柱分型，并评价其临床应用效果。方法2004年12月至2007年3月，304例（323侧）胫骨平台骨折应用三柱分型，其中有4侧单纯压缩骨折，181侧单柱骨折，108侧双柱骨折和30侧三柱骨折。根据三柱分型选择手术入路及内固定方式，外侧柱、内侧柱和后侧柱骨折分别使用前外侧入路、改良正中入路和倒L形入路，对于双柱和三柱骨折则采取联合入路进行手术，术后随访评价临床效果。结果单柱、双柱及三柱骨折的平均手术时间分别是72．3、87．5、97．2min，平均随访20．3个月（12～35个月），随访率为87．8％，平均骨折愈合时问为14．6周，平均完全负重时间为15．9周。术后12个月的SF-36和HSS评分平均为90．7分和87．8分，膝关节活动度为2°-123°。测量术后即刻与术后12个月X线片上的胫骨平台内翻角及后倾角，差异无统计学意义（P〉0．05）。并发症及处理：5例延迟愈合，2例螺钉松动，6例伤口浅表感染及5例部分伤口坏死经伤口处理后治愈，1例深部感染经清创及移除内置物后治愈，另有3例并发腓肠肌后内侧麻木。结论基于CT的胫骨平台骨折三柱分型在指导复杂胫骨平台骨折（特别是累及后柱的骨折）治疗方法的选择上更为可靠。
Objective To evaluate the clinical value of a CT-based three dimensional classification system, ＂Three-Column Classification＂, in treatment of tibial plateau fractures. Methods From December 2004 to march 2007, a new classification system, Three-Column Classification, was used for determining fixation method and surgery approach in 323 cases of tibial plateau fractures prospectively. All the patients were treated with open reduction and internal fixation. According to the Three-Column Classification, there were 4 pure compression fractures, 181 one-column fractures, 108 two-column fractures and 30 three-column fractures. Anterior-lateral, modified midline and reversed L-shaped approaehes were used to treat lateral column, medial column and posterior column fractures respectively. Combined approaches were applied for double-column and three-column fractures. Results The mean operative time for one-column, two-column and three-column fractures were 72. 3, 87. 5, and 97.2 minutes, respectively. With a follow-up rate of 87.8%, 267 cases were followed up for an average of 20. 3 （12 to 35） months. The average radiographic bony union time was 14. 6 weeks and the average full weight-bearing time was 15.9 weeks. The mean Short Form 36 （SF-36） and Hospital for Special Surgery （HSS） scores for all these patients at 12 months postoperatively were 90. 7 and 87.8, respectively. The average ROM of the affected knee joints was 2° to 123°. There were no significant differences in both tibial plateau angle （TPA） and posterior slope angle （PA） on the radiographies between immediate post-operation and 12 months post-operation. Delayed union occurred in 5 cases, and screw loosening in 2 postoperatively. There were 6 cases of superficial infection and 5 ones of partial incision necrosis which were healed with wound management. One deep infection diminished after debridement and implant removal. Numbness in the posterior-inferior part of the calf was recorded in 3 cases.Conclusion CT-based Three-Column Classif
出处
《中华创伤骨科杂志》
CAS
CSCD
2009年第3期201-205,共5页
Chinese Journal of Orthopaedic Trauma
关键词
胫骨骨折
骨折固定术
内
分型
三柱
Tibial fracture
Fracture fixation, internal
Classification
Three-column
