前外侧联合后内侧倒“L”形切口治疗外侧柱合并后外侧柱胫骨平台骨折  

Anterolateral and posteromedial inverted L-shaped approaches for the treatment of tibial plateau fractures involving the lateral and posterolateral columns

作　　者：智春升[1] 邬波[1] 金冶华[1] 刘军[1] 邢犇[1] 

机构地区：[1]沈阳市骨科医院创伤骨科一病房,沈阳110044

出　　处：《中国骨与关节外科》2015年第4期339-343,共5页Chinese Journal of Bone and Joint Surgery

摘　　要：背景：关于胫骨平台外侧柱合并后外侧柱骨折的手术治疗还存在争议。目的：探讨应用前外侧联合后内侧倒＂L＂形入路、双接骨板固定治疗外侧柱合并后外侧柱胫骨平台骨折的效果。方法：回顾性分析2011年1月至2014年1月,采用前外侧联合后内侧倒＂L＂形入路、双接骨板固定治疗的36例前外侧柱合并后外侧柱胫骨平台骨折的患者资料。男30例,女6例;年龄33~51岁,平均36.4岁;均为闭合性骨折;受伤至内固定手术时间为7~12 d,平均9.2 d。术后进行临床及影像学检查,在术后第12个月随访时采用美国特种外科医院（HSS）评分对膝关节功能进行评估。结果：36例患者均获得随访,随访时间12~22个月,平均15.6个月;手术时间110~160 min,平均130 min。术后完全负重时间12~16周,平均13.5周;骨折临床愈合时间10~14周,平均13.6周。术后即刻和12个月患肢胫骨平台内翻角及后倾角比较,差异均无统计学意义（P〉0.05）。膝关节功能HSS评分为88~96分,平均94.3分,均为优。3例患者后内侧切口转角处出现皮缘坏死,经换药后愈合,未发生深部感染。2例小腿后下部麻木,为腓肠内侧皮神经损伤所致,术后1年无恢复。末次随访无1例发生感染、骨折不愈合、复位高度丢失、内固定松动、膝关节不稳及医源性血管损伤等并发症。结论：采用前外侧联合后内侧倒＂L＂形入路、双接骨板固定治疗前外侧柱合并后外侧柱胫骨平台骨折,可直视下完成骨折的复位、固定,无需腓骨小头截骨及显露神经血管,固定牢固,膝关节功能恢复好。Background： The treatment of tibial plateau fractures involving the lateral and posterolateral columns is still in dispute.Objective： To evaluate therapeutic effects of tibial plateau fractures involving the lateral and posterolateral columns（LPCs）by dual locking plate fixation via anterolateral and posteromedial inverted L-shaped approaches.Methods： From January 2011 to January 2014, a total of 36 patients with tibial plateau fractures involving LPCs underwent dual-plate fixation via anteriorlateral and posteromedial inverted L-shaped approaches. There were 30 males and 6 females with a mean age of 36.4 years old（range, 33-51 years）. All were closed fractures. Clinical and X-ray examination were conducted during follow-up. HSS scores was used to evaluate the knee joint function at 12 months after surgery.Results： All the patients were followed up and the mean duration was 15.6 months（range, 12-22 months）. The average operation, full weight bearing and fracture union were 130 min（range110-160 min）, 13.5 weeks（range, 12-16 weeks） and 13.6weeks（range, 10-14 weeks）, respectively. No statistical difference was found in either the tibial plateau angle（TPA） or posterior slope angle（PA） immediately after surgery versus 12 months after surgery（P〉0.05）. All the results according to HSS grading were excellent and the mean HSS score was 94.3（from 88 to 96）. Skin necrosis（about 3 cm） occurred at medial incision in three case at 2 week postoperatively. The woulds were healed by dressing. Leg numbness occurred in 2 cases due to medial sural cutaneous nerve damage, and the symptom still existed one year later. No complications, including infection,nonunion, reduction lost, fixation loosening, keen joint instability, or iatrogenic injuries occurred.Conclusions： Treatment for tibial plateau fractures involving LPCs by dual locking plate fixation via anterolateral and posteromedial inverted L-shaped approaches is a feasible and effective method. Sufficient exposure, good redu

关 键 词：胫骨骨折 骨折固定术 内 内固定器 

分 类 号：R687.3[医药卫生—骨科学]