摘要
目的 探讨三切口入路治疗累及后侧平台的复杂胫骨平台骨折的临床疗效.方法 回顾性分析2014年7月至2016年2月7例复杂胫骨平台骨折接受手术治疗患者的病历资料,男5例,女2例;年龄24～68岁,平均（39.7±15.3）岁.骨折分型根据Schatzker分型均为V型;基于AO/OTA分型均属于41B-3.1型.手术采用三切口入路,侧俯卧位下于膝关节前外侧、后外侧切开并显露胫骨平台,先于后外侧切口内将后侧骨折块固定,再经前外侧切口固定前外侧骨折块,然后转为平卧位,经前内侧切口固定内侧骨折块.影像学评价采用Rasmussen放射学评分以及胫骨平台后倾角和内翻角.末次随访时采用美国特种外科医院（Hospital for Special Surgery,HSS）膝关节功能评分标准评估膝关节功能,Lysholm评分评估膝关节运动情况,Lachman试验及Pivot-shift试验评价膝关节前后及旋转稳定性.结果 7例患者平均手术时间为（3.3±0.9）h,术中出血量平均为（341±106） ml.术后6例切口愈合时间平均为（11.8±1.3）d;余1例肥胖[身体质量指数（BMI）＞ 30 kg/m2]且合并糖尿病患者术后出现切口脂肪液化,愈合时间为21 d.术后随访时间为8～14个月,平均（11.4±2.8）个月.术后完全负重时间为2～3个月,平均（2.5±0.4）个月;骨折愈合时间为8～16周,平均（11.1±2.8）周.术后即刻后倾角为4°～12°,平均8.29°±2.87°;内翻角为84°～88°,平均86.00°±1.41°;Rasmussen放射学评分为14～18分,平均（16.86±1.57）分,优良率100％.术后6个月时后倾角为5°～14°,平均（8.71±2.63）°;内翻角为84°～89°,平均（86.43±1.62）°;Rasmus-sen放射学评分为14～18分,平均（16.57±1.51）分,优良率100％.末次随访时HSS评分为85～100分,平均（93.1±4.8）分,优良率100％;Lysholm评分为90～100分,平均（97.1±3.6）分;所有患者Lachman试验及Pivot-shit试验均为阴性.膝关节活动度为105°～140°,平均128.6°±12.8°.术后X线片显
Objective To evaluate the outcomes of open reduction and internal fixation of complex tibial plateau fractures with improved three combined approaches.Methods In the period from July 2014 to February 2016,7 complex tibial plateau fractures underwent surgical treatment.These patients included 5 male and 2 female,aged from 24 to 68 years old （average,39.7± 15.3 years）.According to Schatzker classification,they were all of type V.And all of type 41B-3.1 by AO/OTA classification.All these fractures were exposed and reduction via three combined approaches.First let the patients lied in lateral prone position,expose the anterolateral and the posterolateral of the tibia1 plateau,and fix the fractures of the posterior in the posterolateral approach,then fix the fractures of the lateral in the anterolateral approach.Then turn the patients to supine position,fix the fractures of the medial in the anteromedial incision.All patients received regular reexamination.The knee function was evaluated at the final follow-up using The Hospital for Special Surgery （HSS） score,the activity of the knee was evaluated by Lysholm score,and the stability of the knee was checked by Lachmantest and Pivot-shift test.The tibial plateau angle,the posterior slope angle and Rasmussen X-ray score were assessed on the X-ray films.Results The average time of operation is （3.3±0.9） h,and the hemorrhage volume in operation was （341± 106） ml for the 7 patients.The wounds of 6 patients healed by （11.8± 1.3） days,while the wound of the rest one of them occurred fat liquefaction after operation who is very fat （BMI 〉 30） and suffered from diabetes.His wound healed by 21 days.These patients obtained follow-ups of 8 to 14 months （average,11.4±2.8 months）.The average full weight-bearing time was 2-3 months （average,2.5±0.4 months）.The fractures healed after 8 to 16 weeks （average,11.1 ±2.8 weeks）.No displacement of the fractures or breakage of the implants occurred in our series.Nobody has activity limitation of t
出处
《中华骨科杂志》
CSCD
北大核心
2017年第12期705-712,共8页
Chinese Journal of Orthopaedics
关键词
胫骨骨折
膝关节
骨折固定术
内
Tibial fractures
Knee joint
Fracture fixation, internal
