三种入路治疗胫骨平台前外侧柱合并后外侧柱骨折的疗效比较  

Comparison of three surgical approaches for fractures of anterolateral and posterolateral columns of tibial plateau

作　　者：李滔[1] 侯开宇[1] 季建华[1] 李灿章[1] 赵庆刚[1] 陈仲[1] 

机构地区：[1]云南省第二人民医院骨与创伤外科,昆明650021

出　　处：《中华创伤骨科杂志》2017年第10期846-853,共8页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨前外联合后外双切口入路、外侧单切口双间隙入路与腓骨颈截骨入路治疗胫骨平台前外侧住合并后外侧柱骨折的临床效果。方法回顾性分析2012年1月至2015年1月期间采用手术治疗的18例胫骨平台前外侧柁合并后外侧柱骨折患者资料。男10例，女8例；年龄28～58岁，平均35．5岁；按照手术入路方式将其分为3组（n=6）：A组患者采用前外联合后外入路治疗，B组患者采用外侧单切口双间隙入路治疗，C组患者采用腓骨颈截骨入路治疗。记录3组患者的手术时间及术后并发症发生情况等。术后3个月和末次随访时采用Raslnussen评分评价骨折复位情况，并采刖美国特种外科医院（HSS）评分评价膝关节功能。结果18例患者术后获10～18个月（平均13．3个月）随访。无伤口感染及深静脉血栓形成等早期并发症发生。A、B组患者的手术时间（平均89．5、79．3min）、术中出血量（平均151．7、207．8mL）均明显少于C组（平均102．5min、260．2mL）。A组患者的切口长度（平均10．5cm）短于B组（平均17．4cm）和C组患者（平均16．3cm）。术后C组骨折复位为优（6例）的患者数稍多于A、B组（均为4例）。木次随访时A、B、C组患者的Rasmussen评分平均分别为16．8、17．0、16．3分，HSS评分平均分别为86．3、86．0、85．7分；以上项目3组间差异均小明显。术后B组出现1例患者切口部分坏死、延迟愈合。末次随访时C组有2例患者内翻应力试验Ⅱ度松弛，2例内翻应力试验I度松弛。结论3种手术入路都能对胫骨平台前外侧住及后外侧柱骨折较好显露，复位固定疗效良好。前外联合后外双切口及外侧单切口双间隙入路有相似的显露范围及固定效果，仇外侧单切口双间隙入路手术操作相对更简单；双切口对前后间隙的显露更充分，更能将前、后2块钢板置于合适的史撑位置。腓骨颔截骨�Objective To compare the clinical effects of combined anterolateral and posterolateral approach, lateral incision via double intermuscular spatia approach, and posterolateral transfibular approach in the treatment of fractures of anterolateral and posterolateral columns of tibial plateau. Methods A retrospeetive analysis was done of the 18 patients with fracture of anterolateral and posterolateral colunms of tibial plateau who had been treated at our hospital from Janual7 2012 to Janual7 2015. They were 10 men and 8 women, aged from 28 to 58 years （mean, 35.5 years）. They were divided into 3 equal groups. Group A was treated with combined anterolateral and posterolateral approach, group B with lateral incision via double intermuseular spatia approach and group C with posterolateral transfibular approach. Operation time, surgical blood loss and complications were recorded. At the final follow-ups, Rasmussen score was used to evaluate the fracture reduction and Hospital for Special Surgery （HSS） knee score to assess functions of the involved knees. Results The 18 patients were followed up for 10 to 18 months （average, 13.3 months）. No such early eomplications as incision infection or deep vein thrombosis occurred. The operation time （89.5 min and 79.3 rain, respectively） and surgical blood loss （151.7 mL and 207.8 mL, respectively） for groups A anti B were obviously less than those for group C （102.5 min; 260.2 mL）; the incision length for group A （10.5 cm） was shorter than that for group B （ 17.4 cm） and for group C （ 16.3 cm）; group C had more cases of excellent reduction （6） than groups A and B （4 for both） . There were no obvious differenees between groups A, B and C in the Rasmussen score （16. 8, 17.0 and 16. 3） or HSS score （86.3, 86. 0 and 85.7）. One case of delayed incision healing due to partial necrosis occurred in group B. At the final follow-ups in group C, the varus stress test showed 2 cases of laxation of degree Ⅱ and 2 cases of laxation of degree

关 键 词：膝关节 骨折固定术 内 病例对照研究 手术入路 分刊 

分 类 号：R687.3[医药卫生—骨科学]