三柱理论在复杂胫骨平台骨折治疗中的应用  

Clinical application of three-column theory in treatment of complex fractures of tibial plateau

作　　者：王立坤[1] 孙正考[1] 于腾波[1] 张亦军[1] 张增方[1] 纪伟[1] 

机构地区：[1]山东大学齐鲁医院青岛院区, 266035

出　　处：《中华创伤骨科杂志》2014年第6期495-498,共4页Chinese Journal of Orthopaedic Trauma

摘　　要：目的 探讨三柱理论在复杂胫骨平台骨折治疗中的临床应用和疗效分析.方法 自2009年1月至2012年1月收治41例复杂胫骨平台骨折,男26例,女15例;年龄23～56岁,平均35.7岁;按照三柱分型：双柱骨折22例,三柱骨折19例.所有患者均采用手术治疗,根据三柱理论采用合理的手术入路及内固定方式.结果 33例患者随访12 ～ 24个月（平均17.4个月）,骨折愈合时间为10～ 15周（平均14.3周）,完全负重时间为12～ 16周（平均14.9周）.膝关节活动度7例伸直受限,受限范围小于10°,平均活动范围121.1°（95°～133°）.3例患者术后前外侧伤口裂开,经换药后愈合,未发生深部感染;无一例患者发生内固定松动及断裂.术后内侧平台后倾角平均为8°（6°～10°）,外侧平台后倾角平均为6°（5°～9°）.根据Rasmussen评分系统评定膝关节功能：优20例,良9例,可4例,优良率为87.9％.结论 利用三柱理论对复杂胫骨平台骨折的手术入路和内固定方式可以起到有效的指导作用,从而提高疗效.Objective To investigate the clinical application and curative effect of three-column theory in the treatment of complex fractures of tibial plateau.Methods From January 2009 to January 2012,41 cases of complex fractures of tibial plateau were treated in our department.Of them,22 were double column fractures and 19 three-column ones according to the three-column classification.All the cases were treated with proper operative approaches and internal fixation based on the three-column theory.Results Of all the patients,33 were followed up for 12 to 24 months （average,17.4 months）.Their fractures healed after 10 to 15 weeks （average,14.3 weeks）.Time for full weight-bearing averaged 14.9 weeks.A limitation of less than 10° to the knee extension was found in 7 cases.The range of motion of the knee averaged 121.1° （from 95° to 133°）.Anterolateral wound dehiscence occurred in 3 cases but was cured by dressing without deep infection.No loosening or breakage occurred.The retroversion angle of the medial plateau averaged 8° （from 6° to 10°） and the retroversion angle of the lateral plateau averaged 6° （from 5° to 9°）.By the Rasmussen evaluation,20 cases were excellent,9 good and 4 fair,giving a good to excellent rate of 87.9%.Conclusion The three-column theory can well guide the choice of operative approach and internal fixation for specific treatment of complex fracture of tibial plateau,thus enhancing the curative effect.

关 键 词：胫骨 骨折 骨折固定术 内 三柱理论 

分 类 号：R687.3[医药卫生—骨科学]