双切口入路治疗复杂胫骨平台骨折的疗效  

Treatment Effect of Complex Tibial Plateau Fracture Through Double-incision

作　　者：杨团民[1] 李红川[1] 张冰[1] 焦宁[1] 同志超[1] 李毅[1] 

机构地区：[1]西安市红十字会医院骨病科,710054

出　　处：《美中国际创伤杂志》2010年第1期32-34,18,共4页U.S.Chinese International Journal of Traumatology

摘　　要：目的：评价双切口入路治疗复杂胫骨平台骨折手术治疗方法及疗效。方法：2008年5月至2009年11月，手术治疗复杂胫骨平台骨折22例，其中男15例，女7例。年龄19～67岁，平均41．6岁。左侧10肢，右侧13肢，1例为双侧，均为闭合性骨折。致伤原因：高处坠落伤9例，交通伤11例，其他2例。按照Schatzker分型标准：Ⅴ型13肢，Ⅵ型10肢。受伤至手术时间5-14d，平均9．4d，均采用双切口入路，双钢板固定手术治疗。结果：所有患者均获随访12～22个月，平均14．6个月。术后骨折愈合时间6～9个月，平均7．4个月。其中1肢因关节面粉碎严重未达到解剖复位；1肢因干骺端粉碎严重未恢复下肢正常力线，出现膝内翻；2肢出现伤口表皮坏死，无骨外露，经换药处理后愈合。膝关节功能按Rasmussen评分标准评定：优10肢，良8肢，可2肢，差3肢。结论：双切口入路降低了软组织的并发症，有利于关节面复位：双钢板固定可靠，可早期行功能锻炼，是一种较好的治疗复杂胫骨平台骨折的手术入路和方法。Objective： To evaluate the surgical treatment and its results of complex tibial plateau fractures. Methods： From May 2008 to November 2009, 22 cases of complex tibial plateau fractures were treated by two-incision approaches. There were 15 male （including 1 case of bilateral fractures） and 7 female, with mean age of 41.6 years （19-67 years）, 10 fractures occurred in left extremity and 13 in the right. No patients suffered from open fracture. Fracture caused by fall from height in 9 cases, by traffic accident in 11 cases and by another causes in 2 cases. According to Schatzker classification, type Ⅴ fracture was found in 13 extremities and type Ⅵ in 10 extremities. All cases were operated with two-incision approaches and double-plates fixation. The operation was performed 5-14 days after injury with mean 9.4 days. Results： All cases were followed up from 12 to 22 months （mean 14.6 months）. Time of the bone healing was 6-9 months, with mean 7.4 months. No reduction of anatomy was achieved because of comminuted fractures of articular surfaces in 1 limb. The line of the lower extrimities did not recoved because of metaphysis comminution in 1 limb, which led to knee varus. Epidermal necrolysis was observed in 2 limbs, and the wound healed after change dressing. The function of the knee was evaluated according to Rasmussen＇s criteria, the results were excellent in 10 limbs, good in 8 limbs, fair in 2 limbs, and poor in 3 limbs. Conclusion： The two-incision approaches can reduce the complications of soft-tissue injury, which is conductive to reduction of articular surface. Double-plates provide a sufficient internal fixation, it can permit early motion of knee joint. Therefore, two-incision approache is an effective surgical approach for treatment of complex tibial plateau fractures.

关 键 词：胫骨平台骨折 内固定 手术入路 

分 类 号：R683.42[医药卫生—骨科学]