改良侧后方入路治疗胫骨平台后方剪力骨折  

Treatment of posterior shearing tibial plateau fractures by modified posteromedial and posterolateral approaches

作　　者：陶杰[1] 杭栋华[1] 王秋根[1] 高伟[1] 朱力波[1] 吴小峰[1] 高堪达[1] 

机构地区：[1]上海交通大学附属第一人民医院骨科,上海200080

出　　处：《中国矫形外科杂志》2008年第24期1863-1866,共4页Orthopedic Journal of China

摘　　要：[目的]探讨改良侧后方入路治疗胫骨平台后方剪力骨折的手术效果。[方法]2003年8月-2006年7月，采用改良的侧后方“L”型入路治疗胫骨平台后方剪力骨折13例。后内侧入路经由半腱肌、半膜肌和腓肠肌内侧头间隙，后外侧人路自胭肌和比目鱼肌间隙分别显露后内与后外侧髁。骨折块直视下复位，用3.5mm“T型”锁定钢板或有限接触加压钢板于胫骨后内或后外侧固定骨块。半月板与韧带损伤均I期修复。[结果]13例患者全部获得12个月以上的随访，随访时间13-16个月，平均14.5个月。术后1个月80°-130°，平均105°；术后3个月90°-135°，平均115.3°；术后12个月膝关节屈伸范围：115°-135°，平均125.1°。术后即刻，术后3个月及1年的TPA和PA度数无统计学差异（P〉0.05）。术后1年膝关节HSS评分86-97分，平均92.1分。无1例发生手术区皮肤坏死、感染或内固定松动。[结论]本组所采用的改良后外侧或后内侧入路可充分暴露胫骨后平台，减少前方大范围剥离所带来的软组织并发症，直视下复位和固定骨折块可以充分防止力线的改变和骨折的再移位，有利于患者良好的膝关节功能恢复。[Objective] A prospective study was designed to describe the patterns of posterior shearing tibial plateau fracture,and to evaluate the early results of surgical treatment by posteromedial or posterolateral approach.[Method] From August 2003 to July 2006,13 patients were identified as having posterior shearing tibial plateau fractures and treated with a L-shaped incision by a posteromedial or posterolateral approach made through the interval of semitendinosus, semimembranosus and the medial head of gastrocnemius or a posterolateral approach made through the gap of popliteus and soleus. A 3.5 mm LC-DCP plate was used as a buttress to support the postero-medial or posterolateral fragment which was visibly reduced. [Result] The average duration of follow-up was 14.5 （range, 13 - 16） months. All fractures healed after index surgery. The flexion of the knees achieved 105°（ranged from 80°-130°） at the first month postoperatively. It was improved to 115.3°（ranged from 90°-135°） at the 3^rd month. One year later, the flexion of the knees achieved 125.1°（ranged from 115°- 135° ）. There was no significant difference between tibial plateau angle （TPA） and posterior slope angle （PA） immediately , 3 months and one year after operation （P 〉 0.05） . According to the HSS system , the mean score was 92.1 （ ranged from 76 - 97） one year after operation. No complication occurred, such as deep infection, necrosis of skin incision or loosening and breakage of internal fixators. [Conclusion]This modified posteromedial and posterolateral approaches could reduce the complications in incision successfully for the direct reduction and buttress fixation of articular fragments, as well as and soft tissue.

关 键 词：胫骨平台后方骨折 侧方入路 膝关节功能 钢板固定 

分 类 号：R687.3[医药卫生—骨科学]