摘要
目的探讨改良前外侧入路胫骨近端锁定加压钢板固定治疗胫骨平台后外侧骨折的近期临床疗效。方法2010年6月至2012年3月采用改良前外侧入路胫骨近端锁定加压钢板固定治疗胫骨平台后外侧骨折并获得随访的患者19例，男11例，女8例；年龄26-55岁，平均38-3岁。均为新鲜闭合性骨折。车祸伤10例，高处坠落伤7例，跌伤2例。合并胫骨平台前十字韧带止点撕脱骨折2例。受伤至手术时间3-15d，平均7．5d。手术均采用膝关节前外侧“S”形皮肤切口，较常规切口偏向后上，用胫骨近端锁定加压钢板固定，术后早期行膝关节功能锻炼。术后复查X线片和CT三维重建，3个月内每月复查X线片，采用Rasmussen膝关节功能评分标准评价膝关节功能。结果手术时间80-120min，平均95min；术中出血量100-400ml，平均180ml。随访时间12-24个月，平均16．2个月。全部获得骨折愈合，愈合时间8～14周。随访期间无内固定松动、断裂、骨不愈合，无膝关节内、外翻畸形和骨折再移位，无膝关节不稳。18例患者达到解剖复位；1例后外侧粉碎骨折脱位患者术后CT提示存在2mm关节面台阶，患者行走2km后出现膝关节轻度疼痛，膝关节伸屈0°-105°。1例患者膝关节伸屈5°90°。Rasmussen膝关节功能评定13-30分，平均（22．9±4．9）分，优10例、良7例、可2例，优良率89．5％。结论改良前外侧入路胫骨近端锁定加压钢板固定治疗胫骨平台后外侧骨折操作简单安全，固定可靠，并发症少。
Objective To investigate the clinical efficacy of locking compression plate fixation through a modified an terolateral approach for posterolateral tibial plateau fractures. Methods From June 2010 to March 2012, 19 patients with pos terolateral fibial plateau fractures underwent locking compression plate fixation through a modified anterolateral approach in our hospital. There were 11 males and 8 females, aged from 26 to 55 years （average, 38.3 years）. The injury causes included traffic accident in 10 cases, fall from height injury in 7 cases and falling injury in 2 cases. Two patients had avulsion fracture of the an- terior cruciate ligament. The modified lateral S-shaped incision was adopted for all patients. All the patients underwent early and suitable rehabilitation after operation. The radiographic and clinical results were evaluated by using X-rays and the Rasmussen score, respectively. Results The average operative time was 95 minutes （range, 80 to 120 minutes）, and the average intraopera- tire blood loss was 180 ml （range, 100 to 400 ml）. All the patients were followed up for 12 to 24 months （average, 16.2 months）. Bone union was obtained in all patients, and the bony union time ranged from 8 to 14 weeks. There was no implant loosening/ breakage, bone nonunion, genu valgum, genu varum, redisplacement of fracture, and knee instability. Anatomic reduction was ob- tained in 18 patients. For one patient with posterolateral comminuted dislocation fracture, CT scan showed a step-off of 2 mm in joint surface after operation, and at final follow-up, the patient suffered from mild pain and the range of motion of the knee joint was 0 to 105 degree. The range of motion of the knee joint was 5 to 90 degree in one patient. The Rasmussen score ranged from 13 to 30 （average, 22.9±4.9）; the results were excellent in 10 cases, good in 7 cases and fair in 2 cases, and the excellent and good rate was 89.5%. Conclusion Locking compression plate fixation through a modified anterolateral approach is an eff
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2013年第9期935-940,共6页
Chinese Journal of Orthopaedics
关键词
胫骨骨折
骨折固定术
内
内固定器
Tibial fractures
Fracture fixation, internal
Internal fixators
