摘要
目的探讨采用扩大前外侧入路治疗累及后外侧胫骨平台的骨折的近期疗效。方法回顾分析2013年1月至2016年7月16例在皖南医学院第一附属医院接受扩大前外侧入路应用3.5 mm倒＂L＂型胫骨近端锁定加压钢板的近端4枚锁定螺钉经排钉技术治疗累及后外侧胫骨平台的骨折患者的临床资料。术后即刻及1.5、3、6、12个月对患者行X线检查，连续测量胫骨平台内翻角（TPA）及后倾角（PA）。采用Rasmussen放射学评分评估复位情况。随访满1年时，采用改良Rasmussen膝关节评分评价膝关节功能恢复情况。采用Lysholm评分评价膝关节软骨损伤、软化及退变。侧方应力试验、拔号实验评价膝关节稳定性。结果本组患者男11例，女5例；年龄25～71岁，平均（47±12）岁。Schatzker分型Ⅱ型9例，Ⅴ型6例，Ⅵ型1例。美国创伤骨科协会（OTA）分型B型9例，C型7例。术后即刻复查X线片显示14例获得解剖复位，2例遗留〈2 mm的台阶。Rasmussen放射学评分14～18分，平均（17.0±1.5）分。X线检查示术后即刻及术后1.5、3、6、12个月TPA差异无统计学意义（F＝0.05，P＝0.99）；同时各时间点PA差异亦无统计学意义（F＝0.02，P＝1.00）。随访满1年时，改良Rasmussen膝关节评分为18～29分，平均（25.0±3.3）分，其中优7例，良8例，中1例，优良率93.75%。膝关节活动范围110°～135°，平均（122±8）°。Lysholm评分（93±4）分。侧方应力试验、拔号实验评价均为阴性。结论采用扩大前外侧入路应用3.5 mm倒＂L＂型胫骨近端锁定加压钢板的近端4枚锁定螺钉经排钉技术治疗累及后外侧胫骨平台的骨折的近期疗效满意，提供了充分的暴露和有效的稳定固定，关节功能及稳定性满意。
ObjectiveTo explore the short-term effects of expanded anterolateral approach in treating fracture involved the posterolateral tibial plateau.MethodsA retrospective analysis of the clinical data from 16 patients undergoing extended anterolateral approach for fracture involved the posterolateral tibial plateau in the First Affiliated Hospital of Wannan Medical College between January 2013 and July 2016 was done. The patients were treated with 3.5 mm proximal ＂L＂ type proximal tibial locking compression plate with four locking screws through the nail row technique. The X-rays examinations were carried out immediately after the operation and at 1.5, 3, 6, and 12 months later, to continuously measure the tibial plateau angle （TPA） and posterior slope angle （PA）. The Rasmussen radiology score was used to assess the reduction. One year later, the modified Rasmussen knee score was used to assess the recovery of knee function, the Lysholm score was applied to evaluate the cartilage injury, softening and degeneration, and lateral stress test and dial test were carried out to evaluate the stability of the knee.ResultsThe group consisted of 11 males and 5 females; aged 25 to 71 years, mean （47±12） years; schatzker type Ⅱ 9 cases, type Ⅴ 6 cases and type Ⅵ 1 case. There were 9 cases of type B in Orthopedic Trauma Association （OTA） classification, and 7 cases of type C. X-ray was immediately performed after operation and it showed that 14 cases got anatomic reduction, 2 cases left〈2 mm of steps. Rasmussen radiology score was 14 to 18 points, mean （17.0±1.5） points. X-ray examination showed no significant difference in TPA immediately after operation and 1.5, 3, 6, 12 months later （F=0.05, P=0.99）, and there was no significant difference in PA among the time points （F=0.02, P=1.00）. At one-year of follow-up, the modified Rasmussen knee score ranged from 18 to 29 with an average of （25.0±3.3） points, of which 7 were excellent, 8 were good and 1 was fair. The excellent and good rate
出处
《中华医学杂志》
CAS
CSCD
北大核心
2018年第5期352-356,共5页
National Medical Journal of China
基金
皖南医学院重点培育基金（WK20142F14）
关键词
胫骨平台骨折
扩大前外侧入路
排钉技术
手术入路
Tibial plateau fracture
Expanded anterolateral approach
Raft technique
Operative approach
