后内侧入路治疗胫骨后侧平台双髁骨折  

Posteromedial approach for treatment of posterior bicondylar tibial plateau fractures

作　　者：杨国跃[1] 贾健[2] 刘智[1] 田永刚[1] 李晓东[1] 侯晓斌[1] 江汉[1] 

机构地区：[1]天津市第三中心医院骨科,300170 [2]天津医院创伤骨科

出　　处：《中华骨科杂志》2015年第1期25-31,共7页Chinese Journal of Orthopaedics

摘　　要：目的探讨后内侧人路治疗胫骨后侧平台双髁骨折的早期临床疗效。方法回顾性分析2010年10月至2013年12月，采用后内侧人路钢板螺钉内固定治疗13例胫骨后侧平台双髁骨折患者资料，男8例，女5例；年龄26～62岁，平均（41．5±6．6）岁；左侧7例，右侧6例。采用膝关节后内侧倒“L”形切口，后内侧髁使用胫骨后内侧解剖锁定钢板或“T”形加压钢板固定，后外侧髁使用3．5mm“T”形接骨板支撑固定，骨缺损明显者使用同种异体骨填充支撑关节面。术后根据Rasmussen放射学评分标准评价骨折复位质量，术后12个月按照美国特种外科医院（hospitalforspecialsurgery，HSS）膝关节功能评分评定疗效。术后通过x线及临床检查判断骨折愈合时间，记录并发症及相应转归。结果13例患者均获得随访，随访时间8-34个月，平均（20．8±9．4）个月；骨折全部愈合，X线愈合时间12-24周，平均（15．6±5．2）周。术后Rasmussen放射学评分为1～18分，平均15．8分；其中优7例，良4例，可2例，优良率为84．6％（11／13）。HSS膝关节功能评分由术前26～48分，平均（38．2±7．8）分，上升至术后12个月时的56～92分，平均（85．2±7．8）分；其中优9例，良2例，可1例，差1例，优良率为84．6％（11／13）。膝关节活动度95°-130°，平均118°。术后6个月出现膝关节慢性疼痛2例，其中1例X线片示膝关节间隙轻度变窄，诊断为创伤性关节炎，经口服非甾体类药物及关节内注射施沛特后膝关节疼痛部分缓解；另1例x线片示膝关节间隙无明显变窄，仅口服非甾体类药物即可缓解疼痛。末次随访，无一例发生皮肤及软组织感染、螺钉松动、断裂等并发症。结论后内侧入路治疗胫骨后侧平台双髁骨折近期可获得满意疗效。Objective To explore the early clinical efficacy of posteromedial approach for treatment of posterior bieondy- lar tibial plateau fractures. Methods From October 2010 to December 2013, data of 13 patients of posterior bicondylar tibial pla- teau fracture who were treated with plate and screw fixation through posteromedial approach were retrospectively analyzed. There were8 males and 5 females, in which 7 cases located in the left knee and 6 cases loeated in the right knee, with an average age of 41.5±6.6 years. An inverted ＂L＂ shaped posteromedial incision was made in the operation. If the fracture line was involving the posteromedial condyle, a locking anatomical plate or ＂L＂ shaped compression plate was used. A 3.5 mm ＂T＂ shaped plate was used to support the posterolateral condyle. Allogeneic bone was used to support the artieular surface in the cases with obvious bone defect. Rasmussen score was used for radiologieal assessment, and HSS knee score was used for efficacy assessment 12 months postoperative. An anteroposterior view and lateral view of the knee were obtained 2, 4, 12 weeks, 6 months and 12 months postoperation. The fracture healing time was judged by X-ray and clinical examinations, additionally, the complications and corre- sponding outcomes were also recorded. Results All 13 patients had obtained an average of 20.8±9.4 months follow-up （range, 8- 34 months）, and all fractures were healed. The healing time in terms of X-ray was 12 to 24 weeks （mean, 15.6±5.2 weeks）. After surgery, the Rasmussen score was 1-18 points （mean 15.8 points）. 7 eases achieved excellent results, 4 good, and 2 fair. The ex cellent and good rate was 84.6%. HSS knee score improved significantly from 38.2±7.8 points （range, 26-48 points） to 85.2±7.8 points （range, 56-92 points） 12 months postoperation, and the results was excellent in 9 cases, good in 2, fair in 1 and poor in 1, with total excellence and good result of 84.6%. The range of knee activity was 95°- 130°. None of the skin and

关 键 词：胫骨骨折 骨折固定术 内 治疗结果 

分 类 号：R687.3[医药卫生—骨科学]