胫骨平台后侧骨折的手术治疗策略及疗效分析  

Operation strategy and curative effect analysis of posterior tibial plateau fracture

作　　者：叶钢[1] 彭朝安 孙华斌[1] 肖兢 喻紫晨 汪洲[1] 

机构地区：[1]湖北省武汉市黄陂区人民医院骨科,430300

出　　处：《中国骨与关节损伤杂志》2013年第8期722-724,共3页Chinese Journal of Bone and Joint Injury

摘　　要：目的探讨胫骨平台后侧骨折的手术治疗方法及疗效。方法自2009年1月-2012年1月共收治53例闭合性新鲜胫骨平台后侧骨折。所有患者人院后常规行X线摄片和64排CT三维重建。根据CT下“三柱理论”分类：其中后外侧柱骨折12例，后内侧柱骨折26例，后内侧及后外侧均有骨折者15例。采用膝关节后侧倒L形入路切开复位、桡骨远端T形普通钢板或锁定钢板固定15例，采用膝关节后内侧纵形人路切开复位、钢板固定26例，采用膝关节后外侧纵形人路切开复位、钢板或螺钉固定12例。术后按AKS评分评价膝关节功能恢复情况。结果53例术后获12～30个月随访，末次随访时AKS评分平均87（58—95）分，15例采用膝关节后侧倒L形入路者AKS评分平均82（58～90）分。26例采用后内侧纵形入路者AKS评分平均91（70~95）分，12例采用后外侧纵形入路者AKS评分平均85（65—92）分。结论对于不同类型的胫骨平台后侧骨折．术前慎重评估软组织损伤．选用适当的手术人路与内固定方法．可以获得较好的疗效．Objective To explore the surgical management and curative effect of posterior tibialplateau fracture. Methods From January 2009 to January 2012, 53 patients with posterior tibial plateau fracture who had underwent conventional X-ray and 64 lines of CTs3D reconstruction after admission, were divided into three groups according to the ＂Three-Column Theory＂ under CT： posterolateral fracture （n=12）, posteromedial fracture （n=26）, both posteromediai and posteromedial fracture （n=15）. Three different surgical procedures was employed in these cases, including conventional plates or locking plates of distal radius fLxation via a posterior inverted ＂L＂ shaped approach （n=15）; fixing with plates through a posteromidial longitudinal approach （n=26）, applying plates or screws via a posterior longitudinal approach （n=12）. Then the knee joint function recovery of patients was estimated according to the ASK scoring system. Results All patients were followed up for 12-30 months, and a mean ASK score of 87 points（range 58-95） at last follow-up. Patients underwent the different operation methods above-mentioned got an average ASK score of 82（range 58-90）, 91（range 70-95） and 85（range 65-92） points, respectively. Conclusion To evaluate the soft tissue injury carefully before operation and to choose appropriate surgical method for different types of posterior tibial plateau fracture can get better curative effect.

关 键 词：胫骨平台后侧骨折 普通钢板 锁定钢板 入路 内固定 

分 类 号：R687.3[医药卫生—骨科学]