漂浮体位下治疗累及后柱的复杂胫骨平台骨折  

Surgical treatment for complex tibial plateau fractures involving the posterior column with posteromedical approach in floating position

作　　者：侯训凯 王国伟[1] 石恩东[1] 孙庆山[1] 王炳臣 林永杰[1] 毛军胜[1] 孙立民[1] 

机构地区：[1]山东省交通医院骨科,济南市无影山中路12号250031

出　　处：《中国矫形外科杂志》2015年第22期2052-2056,共5页Orthopedic Journal of China

摘　　要：[目的]探讨漂浮体位下治疗累及后柱的复杂胫骨平台骨折的近期疗效。[方法]2009年5月~2014年6月收治的累及后柱的复杂胫骨平台闭合骨折患者67例,随机分为漂浮体位（floating position,FP）组与传统体位（traditional position,TP）组。FP组35例,采用漂浮体位,应用膝关节前外侧＋后内侧倒＂L＂形入路行骨折切开复位内固定术。TP组32例,采用传统手术体位,应用膝关节前方入路和后方＂S＂形入路行骨折切开复位内固定术。[结果]所有患者均获得随访,随访时间12~28个月,平均21.4个月。手术时间FP组（121.25±26.15）min明显短于TP组（172.78±28.73）min（P〈0.01）;术中出血量FP组（302.43±47.96）ml显著少于TP组（410.78±65.47）ml（P〈0.01）;骨折愈合时间FP组（93.17±12.15）d明显早于TP组（105.28±13.26）d（P〈0.01）;完全负重时间FP组（105.34±16.23）d明显早于TP组（118.58±15.85）d（P〈0.01）。此外,术后6个月膝关节活动度FP组优于TP组（P〈0.05）,术后1年HSS膝关节评分前者明显高于后者（P〈0.01）,但并发症发生情况两组间的差异没有统计学意义（P〉0.05）。[结论]漂浮体位下应用膝关节后内侧倒＂L＂形入路手术治疗累及后柱的复杂胫骨平台骨折,近期疗效满意。[ Objective] To investigate the clinical resuhs of operative treatments for complex tibial plateau fractures invol- ving the posterior column with posteromedical approach in floating position. [ Method ] From May 2014 to June 2009, open re- duction and internal fixation were conducted in 67 patients with complex tibial plateau fractures involving posterior column ,who were randomly divided into the floating position （FP）group and the traditional position （TP） group. Thirty-five patients in the FP group were treated through a lateral approach combined with a posteromedical inverted ＂L＂ shaped incision in floating posi- tion,while the remaining 32 patients in the TP group underwent operation through anterior incisions in the supine position, com- bined with a posterior ＂ S＂ shaped incision in the prone position. [ Result] All the 67 patients were followed up for 12 - 28 months with an average of 21.4 months. Compared between two groups, the FP took advantages over the TP in length of operation （ 121.25 ± 26.15 min versus 172.78 ± 28.73 min,P 〈 0.01 ） ,intraoperative blood loss （302.43 ± 47.96 ml versus 410.78 ± 65.47 ml, P 〈 0.01 ）, fracture healing （ 93.17 _± 12.15 days versus 105.28 ± 13.26 days, P 〈 0.05 ）, and time to full weight - beating after surgery （ 105.34 ± 16.23 days versus 118.58± 15.85 days, P 〈 0.01 ）. Additionally, range of motion and the HSS scores were also significantly higher in the FP group than those in the TP group （P 〈 0.05 ）. However, there were no signif- icant differences in postoperative complications between the two groups （ P 〉 0.05 ）. [ Conclusion ] Surgical treatment for com- plex tibial plateau fractures involving the posterior column with the posteromedical inverted ＂L＂ shaped approach in floating po- sition can obtain a satisfactory therapeutic effect.

关 键 词：胫骨平台骨折 漂浮体位 后柱 

分 类 号：R687.3[医药卫生—骨科学]