摘要
目的:探讨复杂胫骨平台伴后髁骨折采用前正中切口联合后路小切口,前正中切口联合后路微小切口两种术式治疗后的疗效。方法:回顾性研究2000年至2008年79例共81肢复杂胫骨平台伴后髁骨折,39肢行前正中切口联合后路小切口,男21肢,女18肢;按Schatzker分类:Ⅳ型13肢,Ⅴ型15肢,Ⅵ型11肢。42肢行前正中切口联合后路微小切口,男25肢,女17肢(男24例,女16例,其中男1例和女1例为双侧复杂胫骨平台伴后髁骨折);按Schatzker分类:Ⅳ型18肢,Ⅴ型16肢,Ⅵ型8肢。术后采用Rasmussen膝关节功能和放射学评分法评估疗效,并观察皮肤坏死、切口感染等并发症出现情况。结果:所有病例均获随访,按Rasmussen膝关节功能评估:后路小切口组优16肢,良13肢,可7肢,差3肢;后路微小切口组优19肢,良11肢,可8肢,差4肢,两组比较P=0.924。按Rasmussen膝关节放射学评级标准评估:后路小切口组优16肢,良13肢,可7肢,差3肢;后路微小切口组优19肢,良11肢,可8肢,差4肢,两组比较P=0.722。出现皮肤坏死、切口感染等并发症:小切口组10肢,微小切口组4肢,两组比较P=0.047。结论:采用后路小切口与后路微小切口治疗胫骨平台伴后髁骨折在膝关节功能康复方面无明显差异,后路微小切口较后路小切口有更小的皮肤坏死和切口感染率。
Objective：To study the therapeutic effects of combined anterior posterior（small incision or micro incision） approach for complex tibial plateau and posterior condylar fractures.Methods：From 2000 to 2008,79 patients（81 limbs） with complex tibial plateau and posterior condylar fractures were reviewed.There were 45 males and 34 females,ranging in age from 19 to 66 years,with an average of 40.6 years.Thirty nine limbs were treated using small incision through combined anterior posterior approach,in which 13 limbs were Schatzker typeⅣ,15 limbs were typeⅤ,and 11 limbs were typeⅥ.Other 42 limbs were treated using micro incision through combined anterior posterior approach,in which 18 limbs were Schatzker typeⅣ,16 limbs were typeⅤ,and 8 limbs were typeⅥ.The Rasmussen scores for knee joint and radio scores were used to evaluate therapeutic effects after the treatment.The complications such as cutaneous necrosis and incision infection were observed.Results：All the patients were followed up.According to Rasmussen criterion,in small incision group,16 limbs got an excellent result,13 good,7 fair and 3 bad;in micro incision group,above data were 19,11,8 and 4 respectively.Comparison between the two groups,P=0.924.Comparison of complications such as cutaneous necrosis and incision infection：in small incision group,10 limbs had the complications,and in micro incision group were 4 limbs;the occurrence rate of small incision group were higher than that of micro incision group（P=0.047）.Conclusion：There are no significant differences between the two groups in the knee joint function rehabilitation;however,there is smaller rate for cutaneous necrosis and incision infection in micro incision group.
出处
《中国骨伤》
CAS
2010年第6期417-420,共4页
China Journal of Orthopaedics and Traumatology
关键词
胫骨骨折
外科手术
膝关节
手术后并发症
病例对照研究
Tibial fractures
Surgical procedures
operative
Knee joint
Postoperative complications
Case control studies
