三柱理论指导下手术治疗复杂胫骨平台骨折的疗效分析  

Three-column classifi cation in the treatment of complex tibial plateau fractures

作　　者：智春升[1] 邬波[2] 金冶华[2] 刘军[2] 邢犇[2] 

机构地区：[1]辽宁中医药大学,沈阳110847 [2]沈阳市骨科医院创伤骨科,110044

出　　处：《中国骨与关节杂志》2016年第6期473-477,共5页Chinese Journal of Bone and Joint

摘　　要：目的探讨在三柱理论指导下手术治疗复杂胫骨平台骨折的疗效。方法回顾性分析2010年5月至2014年5月,在三柱理论指导下手术治疗的82例复杂胫骨平台骨折的患者资料,男58例,女24例;年龄27~58岁,平均35.6岁;均为闭合性骨折;按照三柱分型其中双柱骨折48例,三柱骨折34例,所有患者均采用手术治疗,受伤至内固定手术时间为5~16天,平均9.6天。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（hospital for special surgery）评分对膝关节功能进行评估。结果82例均获得随访,随访时间12~30个月,平均16.4个月;手术时间90~160 min,平均110 min。术后完全负重时间12~16周,平均13.2周;骨折临床愈合时间10~14周,平均13.2周。术后即刻和12个月在X线片上测量的患肢胫骨平台内翻角及后倾角度数比较,差异均无统计学意义。术后12个月膝关节HSS评分为66~94分,平均83.6分,优良率为86.6%;术后12个月膝关节活动度平均为1.5°~115°。6例延迟愈合,4例切口浅表感染,7例因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。4例深部感染经清创及移除内置物后治愈,2例小腿后内部麻木,下肢深静脉血栓形成（deep venous thrombosis,DVT）21例,其中12例行下腔静脉滤器置入。结论三柱理论可对复杂胫骨平台骨折的手术入路和内固定方式起到有效的指导作用,可直视下完成骨折的复位、固定确实,膝关节功能恢复好。Objective To investigate and evaluate the effects of three-column classifi cation in the treatment of complex tibial plateau fractures. Methods From May 2010 to May 2014, three-column classifi cation was used in the determination of the fi xation method and surgical approach in 82 cases of closed complex tibial plateau fractures. The group included 58 males and 24 females aged from 27 to 58 years old（ average： 35.6 years）. According to the threecolumn classifi cation, there were 48 two-column fractures and 34 three-column fractures. The average period from the injury to the surgery was 9.6 days（ range： 5- 16 days）. Postoperative clinical and radiographical examinations were taken. Knee functions were evaluated by hospital for special surgery（ HSS） 12 months postoperatively. Results All patients obtained follow-up and the average follow-up was 16.4 months（ range： 12- 30 months）. The average time of the surgery, full weight bearing and fracture union were 110 min（ range： 90- 160 min）, 13.2 weeks（ range： 12-16 weeks） and 13.2 weeks（ range： 10- 14 weeks） respectively. No statistical differences were found in either the tibial plateau angle（ TPA） or posterior slope angle（ PA） when comparing the measurement results immediately after the surgery and 12 months postoperatively on radiographs. The mean HSS 12 months postoperatively was 83.6 points（ range： 66- 94 points） with the excellent and good rate 86.6%. The average range of motion（ ROM） of the affected knee joints was 1.5° to 115° 12 months postoperatively. Delayed union occurred in 6 cases. There were 4 cases of superfi cial infection and 7 of partial incision necrosis, and all were healed with wound management. Deep infection in 4 cases was healed after the debridement and implant removal. Numbness in the posterior-inferior part of the calf was recorded in 2 cases. Deep vein thrombosis of the lower extremity was found in 21 cases, and 12 of them were placed inferior vena cava fi lter. Conclusions Three-col

关 键 词：胫骨 骨折 关节内骨折 骨折固定术 内 

分 类 号：R687.3[医药卫生—骨科学]