翻转体位前后联合入路治疗复杂胫骨平台骨折  

Posteromedial and anterolateral approaches in flipping supine position in the treatment of complex tibial plateau fractures

作　　者：衡科[1] 张云坤[1] 

机构地区：[1]南京医科大学附属常州市第二人民医院骨科,213003

出　　处：《中国实用医药》2014年第30期12-14,共3页China Practical Medicine

摘　　要：目的 探讨翻转体位前后联合入路治疗复杂胫骨平台骨折的手术体位、手术入路、手术方法和临床疗效。方法 回顾性分析采用翻转体位前后联合入路治疗且随访完整的15例复杂胫骨平台骨折患者的临床资料。均采用翻转体位后内侧倒＂L＂形入路联合前外侧入路行钢板螺钉内固定,关节面塌陷者采用同种异体骨或自体髂骨植骨术。结果 所有患者获得随访,随访时间8~24个月,平均随访16.3个月,全部病例获得影像学上的骨性愈合,愈合时间l6~26周,平均愈合时间20周。术中未出现血管、神经损伤,术后无内固定松动及断裂,术后1例出现浅表伤口感染。术后末次随访Rasmussen膝关节功能评分为15~28分,平均24.3分,其中优6例,良7例,可2例,优良率86.7%。术后末次随访Rasmussen放射学评分12~18分,平均评分16.7分,其中优9例,良5例,可1例,优良率93.3%。结论 对于涉及后方平台的复杂胫骨平台三柱骨折,翻转体位前后侧联合入路可以很好地暴露骨折块,复位良好,并发症少,近期取得满意疗效。Objective To investigate the operative position, operative approach, operative method and clinical effect of posteromedial and anterolateral approaches in flipping supine position in the treatment of complex tibial plateau fractures. Methods The clinical data of 15 cases of complex tibial plateau fracture, which underwent the treatment of posteromedial and anterolateral approaches in flipping supine position with completed follow-up, were retrospectively analyzed. All cases were treated by posteromedial converse ＂L＂ approach and anterolateral approach in flipping supine position with steel screw internal fixation. Allograft bone or autogenous iliac bone transplantation were conducted for articular surface collapse. Results All the cases were followed up for 8 to 24 months, and the average time were 16.3 months. All cases had imaging bone union with the healing time ranged from 16 to 26 weeks, and the average time was 20 weeks. There were no intraoperative blood vessel or nerve injuries and postoperative internal fixation loosening or breakage occurred, while 1 case of postoperative superficial wound infection appeared. Rasmussen knee function score in the last follow-up was 15-28 points with an average score as 24.3 points, and there were 6 excellent cases, 7 good cases and 2 fair cases with the good rate as 86.7%. Postoperative Rasmussen radiologic score in the last follow-up was 12-18 points with an average score as 16.7 points. There were 9 excellent cases, 5 good cases and 1 fair case with the good rate as 93.3%. Conclusion Posteromedial and anterolateral approaches in flipping supine position of treating complex tibial plateau fractures can expose the fractures block with good fixation and less complication, and its short-term effect is satisfying.

关 键 词：胫骨骨折 翻转体位 手术入路 

分 类 号：R687.3[医药卫生—骨科学]