经双切口入路手术治疗胫骨平台双髁骨折  

Operative treatment of bicondylar tibial plateau fractures through dual incisions approaches

作　　者：冯万文[1] 夏亚一[2] 徐杏荣[1] 李春辉[1] 武茹[1] 王翠芳[2] 钱元[1] 李婷[1] 党跃修[2] 仲翔宇[1] 

机构地区：[1]徐州医学院附属连云港市东方医院骨科,连云港市涉外医院骨科,江苏连云港222042 [2]兰州大学第二医院骨科,兰州730030

出　　处：《中国矫形外科杂志》2011年第20期1693-1696,共4页Orthopedic Journal of China

摘　　要：[目的]评价经膝关节前外侧和后内侧双切口入路手术治疗胫骨平台双髁骨折的临床疗效。[方法]自2003年6月～2010年5月对42例胫骨平台双髁骨折采用膝关节前外侧和后内侧双切口入路进行手术治疗,其中SchatzkerⅤ型骨折29例,SchatzkerⅥ型骨折13例。随访时间16～27个月。观察切口感染和骨折愈合时间。配对t检验比较术后初次和末次随访骨折复位及复位丢失放射学Rasmussen评分。随访末HSS评分评价膝关节功能。[结果]切口感染7例,其中浅部感染2例,深部感染5例,感染率16.67%。骨折平均愈合时间(4.60±1.27)个月。术后初次放射学Rasmussen平均评分(13.86±3.23)分,随访末期(13.71±3.26)分,二者比较差异无统计学意义(P=0.08>0.05)。随访末膝关节功能HSS评分平均为(74.33±12.34)分,优10例,良22例,可9例,差1例,优良率76%。[结论]采用膝关节前外侧和后内侧双切口手术入路可充分暴露膝关节内结构及胫骨平台双髁骨折端,为骨折直视下精确复位和植骨内固定提供了良好的操作空间,关节面复位满意,内固定牢固,术后骨折复位丢失率低、骨折愈合率高,有效减少软组织并发症,利于膝关节功能恢复,适合胫骨平台双髁骨折的手术入路。[Objective] To evaluate the clinical results of bicondylar tibial plateau fractures treated through dual incisions of anterolateral and posteromedial approaches in the knee.[Method]From June 2003 to May 2010,42 patients with bicondylar tibial plateau fractures were treated through dual incisions of anterolateral and posteromedial approaches.There were 29 Schatzker type Ⅴ fractures and 13 Schatzker type Ⅵ type fractures according to the Schatzker classification.The follow-up ranged from 16 to 27 months.Infection incidence of incisions were observed and fracture reduction were radiographically assessed by Rasmussen scores.The knee function was evaluated by HSS scores.[Result]There were were incisions infection in 7 cases,consisted of the superficial infection in 2 cases and the 5 cases of deep infection,and the overall infection rate was 16.67%.The mean healing time of fractures was 4.60±1.27 months.The primary Rasmussen scores postoperatively were 13.86±3.23 points,and the Rasmussen scores at latest follow-up were 13.71±3.26 points.There was no significant difference（P=0.080.05）.The mean HSS scores at latest follow-up was 74.33±12.34 points.Ten cases showed excellent,22 good,9 fair and one poor results.The excellent and good results were 76%.[Conclusion] Dual incisions approaches can fully expose intraarticular structures and fracture ends,which can supply enough operative space for visual reduction,bone grafting and internal fixation.The incisions fits for operative approaches of bicondylar tibial plateau fractures.This technjque has advantages of lower soft tissue complicatins,accurate articular reduction,stable internal fixation,lower loss of reduction,high fracture healing and good function recovery.

关 键 词：双切口入路 胫骨平台双髁骨折 内固定 锁定加压钢板 

分 类 号：R687.3[医药卫生—骨科学]