切断腓肠肌内侧头的后内侧入路内固定治疗胫骨平台后柱骨折  

Tibial plateau posterior column fractures treated via the posteromedial approach dissecting the gastrocnemius medial head

作　　者：赵祖发 于利[1] 汤欣[1] 孙立众[1] 高天虎 李长洲[1] Zhao Zufa;Yu Li;Tang Xin;Sun Lizhong;Gao Tianhu;Li Changzhou(Department of Orthopaedics and Trauma,The First Affiliated Hospital to Dalian Medical University,Dalian 116000,China)

机构地区：[1]大连医科大学附属第一医院创伤骨科(赵祖发现在华润武钢总医院骨科工作),116000

出　　处：《中华创伤骨科杂志》2018年第8期724-728,共5页Chinese Journal of Orthopaedic Trauma

摘　　要：目的 探讨切断腓肠肌内侧头的后内侧入路内固定治疗胫骨平台后柱骨折的手术方法和临床疗效.方法 回顾性分析2013年7月至2016年9月大连医科大学附属第一医院创伤骨科采用切断腓肠肌内侧头的后内侧入路内固定治疗且随访资料完整的7例胫骨平台后柱骨折患者资料.男6例,女1例;年龄38 ～61岁,平均49.3岁.骨折按AO/OTA分型：41-B3.1型1例,41-B3.3型4例,41-C3.1型、41-C3.3型各1例;按三柱分型：三柱骨折3例,后柱合并内侧柱双柱骨折2例,单纯后柱骨折2例.后柱骨折形态：5例为后内柱劈裂合并后外柱塌陷骨折,2例为后内柱骨折;按Schatzker分型：Ⅳ型5例,Ⅴ型1例,Ⅵ型1例.术后参照Rasmussen标准评估骨折复位情况,末次随访时采用美国特种外科医院（HSS）膝关节评分系统评定膝关节功能,同时观察并记录术后并发症的发生情况.结果 术中探查后交叉韧带止点断裂1例,外侧半月板受损2例,均予修补,胫骨向外上脱位合并游离骨块脱入股骨髁外侧嵌顿1例.术后手术切口均一期愈合,无重要血管、神经损伤.7例患者术后获8 ～12个月（平均11.4个月）随访,均获得骨性愈合,愈合时间12 ～16周,平均14.3周.术后Rasmussen复位评分平均为17.7分;术后及末次随访时后倾角平均分别为9.5°、10.8°,内翻角平均分别为86.7°、87.3°.末次随访时HSS膝关节评分平均为91.4分,未发生明显复位丢失、内固定物松动、感染、畸形愈合等并发症.结论 切断腓肠肌内侧头的后内侧入路能很好地暴露整个胫骨平台后柱,有利于骨折解剖复位和内固定物的安置,无明显并发症发生,近期疗效良好.Objective To discuss the treatment of tibial plateau posterior column fractures via the posteromedial approach which dissects the medial head of the gastrocnemius muscle.Methods From July 2013 to September 2016,7 patients were treated at Department of Orthopaedics and Trauma,The First Affiliated Hospital to Dalian Medical University by surgery via the posteromedial approach dissecting the medial head of the gastrocnemius muscle for tibial plateau posterior column fractures.They were 6 men and one woman,aged from 38 to 61 years （49.3 years on average）.According to AO/OTA classification,4 cases belonged to type 41-B3.3,one to type 41-B3.1,one to type 41-C3.3 and one to type 41-C3.1.According to the three-column classification,3 cases were categorized into three-column fracture,2 cases into fracture of both medial and posterior columns,and 2 cases into simple posterior column fracture.Of the posterior column fractures,5 had the medial posterior column split and the lateral column collapsed,and 2 had the medial posterior column split.According to Schatzker classification,5 cases were categorized into type Ⅳ,one into type Ⅴ and one into type Ⅵ.Fracture reduction was assessed according to the Rasmussen criteria postoperation.The knee function was assessed at final follow-ups using The Hospital for Special Surgery （HSS） scoring system.The postoperative complications were documented.Results Insertion rupture of the posterior cruciate ligament was found in one case,lateral meniscus injury in 2 cases,and tibial external dislocation combined with bone fragment incarceration into the lateral femoral condyle in one case.All the lesions were repaired.All the incisions were healed at the first stage.No major neurovascular injuries were found.The 7 patients were followed up for 8 to 12 months （mean,11.4 months）.Bony union was achieved in all after 12 to 16 weeks （mean,14.3 weeks）.The postoperative Rasmussen reduction scores averaged 17.7 points.The average tibial plateau tilt angle was 9.5°postoperatively

关 键 词：胫骨 骨折 骨折固定术 内 后内侧入路 腓肠肌内侧头 

分 类 号：R687.3[医药卫生—骨科学]