累及后柱的复杂胫骨平台骨折的手术治疗  

The clinical effect of surgical treatment of complex tibial plateau fractures involving the posterior column

作　　者：孙晟轩[1] 徐建[1] 王烨[1] 董启榕[1] 周海斌[1] 

机构地区：[1]苏州大学附属第二医院骨科,江苏苏州215004

出　　处：《中国矫形外科杂志》2014年第6期499-502,共4页Orthopedic Journal of China

摘　　要：[目的]探讨手术治疗累及后柱的复杂胫骨平台骨折的临床疗效。[方法]选择本院2009年12月～2012年4月收治的累及胫骨平台后侧部分骨折的患者34例，男24例，女10例，年龄24～57岁，平均（41．6±2．3）岁。按“三柱理论”分型：单纯后柱骨折4例，双柱骨折17例，三柱骨折13例。单柱骨折予以单纯后路倒“L”型入路，双柱骨折予以后路倒“L”型或联合前外侧入路，三柱骨折予以后侧联合前外侧手术人路，随访期间测量胫骨平台内翻角及后倾角，按照美国特种外科医院膝关节功能评分法（HSS）对膝关节功能进行评分。[结果]34例患者全部获得随访，随访时间12～26个月，平均（18．5±3．1）个月。骨折愈合时间14～23周，平均（16．3±1．8）周。术后1年膝关节活动度117．5°±8．6°，所有患者术后即刻与术后1年胫骨平台内翻角及后倾角无统计学差异，末次随访时HSS评分：优19例（55．9％）、良10例（29．4％）、一般3例（8．8％），差2例（5．9％），优良率为85．3％。[结论]对于累及后侧份的复杂胫骨平台骨折，按照“三柱理论”进行分型及治疗，可获得稳定的解剖复位及坚强内固定，可早期行功能锻炼，减少并发症的发生。[ Objective] To investigate the clinical effect of surgical treatment of complex tibial plateau fractures involving the posterior column. [ Method] From December 2009 to April 2012,34 patients of complex tibial plateau fractures involving the posterior column were treated in the second affiliated hospital of Soochow University. This study involved 24 males and 10 femo- ral, with an average age of 41.6 ± 2.3 years （range,24 to 57）. According to Three-Column Classification, there were 4 one-col- umn fractures, 17 two-column fractures, 13 three-column fractures, of which one-column fractures were treated with posteromedial reversed L-shaped approach, two-column fractures with posteromedial and anterolateral approach, three-column fractures with posteromedial reversed L-shaped and anterolateral approaches. We analysed TPA and PA on radiographies in follow-up, HSS scores was used to evaluate the knee function of post-operation. [ Result] All patients were obtained foUow-up data,with an aver- age of 18.5 ± 3.1 months and average union time of 16.3 ± 1.8 weeks. The averger ROM of the affected knee joints was 117.5° ± 8.6°. There were no significant differences in either the TPA or PA between immediately and one year after operation. The re- sult of HSS scores was excellent in19 patients, good in 10, fair in 3, poor in 2, with a good to excellent result rate of 85.3%. [ Conclusion]Three-Column Classification plays a instructive role in the treatment of complex tibial plateau fractures involving the posterior column, which can result in anatomic reduction, satisfactory fixation and early functional rehabilitation.

关 键 词：胫骨平台骨折 后柱 骨折内固定术 

分 类 号：R687.3[医药卫生—骨科学]