侧后方入路治疗胫骨平台后方剪切骨折的临床效果观察  

The clinical observation of posteromedial and posterolateral approaches in the treatment of posterior shearing tibial plateau fractures

作　　者：孙启彬[1] 王玉[1] 孟庆军[1] 于庆才[1] 

机构地区：[1]济南市第三人民医院脊柱关节科,250101

出　　处：《中国矫形外科杂志》2014年第6期503-507,共5页Orthopedic Journal of China

摘　　要：[目的]探讨侧后方入路治疗胫骨平台后方剪切骨折的临床效果。[方法]回顾分析2009年1月～2012年4月收治的46例行侧后方入路治疗的胫骨平台后方剪切骨折患者的临床资料，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，骨折块直视下复位后采用“T”型支撑钢板固定。术后随访观察固定效果及临床疗效。[结果]患者均获随访，时间12～32个月[（22±0．3）个月]。所有患者均未发生术区皮肤坏死、感染或内固定松动等手术并发症。影像学评估：术后即刻和术后1年的后倾角、内翻角的差异均无统计学意义（P〉0．05）。末次随访HSSI临床功能评分平均87．6分，依据Rasmussen标准评价临床疗效：优27例（58．7％）、良13例（28．3％）、可6例（13．0％）。[结论]侧后方入路可充分暴露胫骨后平台，降低前方入路广泛剥离导致的软组织并发症，直视下复位关节面固定牢靠，患者术后膝关节功能良好，是较好的手术治疗策略。[ Objective ] To investigate the clinical effect of posteromedial and posterolateral approaches in the treatment of posterior shearing tibial plateau fractures and provide the reference for the clinics. [ Method] A retrospective analysis of 46 pa- tients with posterior shearing tibial plateau fractures from Jan 2009 to Apr 2012 in our hospital were included in this study. All the patients were treated by posteromedial and posterolateral approaches. Posteromedial approach was made through the interval of semitendinosus, semimem branosus and the medial head of gastrocnemius, posterolateral approach was made through the gap of popliteus and soleus, a ＂T＂ shape buttress plate was used to fixe the posteromedial or posterolateral fragment which was visi- bly reduced. All the patients were followed up,the fixation and clinical effect were observed after operation. [ Result ] All cases were followed up for 12 -32 months with an average of （22 ± 0.3） months. There was no complication such as necrosis of skin incision, infection,loosening and breakage of internal fixators during the follow - up period. Radiographic assessment： there was no significant difference between tibial plateau angle and posterior slope angle immediately and one year after operation（P 〉0. 05）. The average HSS score at the final follow-up was 87.6. The clinical outcomes were determined using Rasmussen criteria, which revealed that 27 （58.7%） patients had excellent resuh,13 （28.3%） good and 6 （ 13.0% ） fair. [ Conclusion]The ad- vantages of posteromedial and posterolateral approaches include reduction of articular surface under visualization, firm fixation, less complications, and earlier functional exercise, so it is an ideal surgical treatment plan for posterior shearing tibial plateau fractures.

关 键 词：胫骨平台后方骨折 后方入路 钢板固定 膝关节功能 疗效 

分 类 号：R687.3[医药卫生—骨科学]