可视三窗口的改良后内侧倒“L”入路治疗复杂胫骨平台骨折19例临床观察  

Clinical Observation of Treatment of Complicated Tibial Plateau Fracture in 19 Patients Via Modified Three-window Medial Inverted "L-shaped" Approach

作　　者：张擎柱[1] 张义[1] 何志勇[1] 邱宇辰 翟栋[1] 金宇[1] 闫石[1] 杨小华[1] 付世杰[2] 李哲[3] ZHANG Qing-zhu;ZHANG Yi;HE Zhi-yong;QIU Yu-ehen;ZHAI Dong;JIN Yu;YAN Shi;YANG Xiao-hua;FU Shi-jie;LI Zhe(Department of Traumatolog;Hand and Foot Surger;Department of Spinal Surgery,Affiliated Hospital of Chengde Medical College,Chengde,Hebei 067000,China)

机构地区：[1]承德医学院附属医院创伤骨科,河北承德067000 [2]承德医学院附属医院手足外科,河北承德067000 [3]承德医学院附属医院脊柱外一科,河北承德067000

出　　处：《临床误诊误治》2018年第10期37-41,共5页Clinical Misdiagnosis & Mistherapy

基　　金：河北省科技计划项目(162777180)

摘　　要：目的探讨可视三窗口的改良后内侧倒"L"入路治疗复杂胫骨平台骨折的临床效果。方法回顾性分析2013年4月—2017年4月承德医学院附属医院创伤骨科采用可视三窗口(后内侧窗口、后外侧窗口、前内侧窗口)的改良后内侧倒"L"入路手术治疗复杂胫骨平台骨折19例的临床资料,记录每位患者的手术时间、骨折愈合情况及愈合时间,以及术后并发症发生情况。术后随访行膝关节功能评估[美国特种外科医院膝关节评分(HSS)]及胫骨平台骨折复位放射学评估(Rasmussen评分)。结果本组19例手术时间为(137. 3±32. 4) min,均获骨性愈合,愈合时间(15. 5±3. 7)周。19例均获随访(23. 1±4. 2)个月,末次随访HSS评分为71~100分,优良率94. 7%,Rasmussen评分为6~18分,优良率89. 5%。术后发生切口裂开、切口皮缘部分坏死、小腿感觉麻木、内固定螺钉松动各1例,均未影响骨折愈合。结论可视三窗口的改良后内侧倒"L"入路治疗复杂胫骨平台骨折,能够充分显露手术区域,直视下精准复位,从而最大限度实现关节面的解剖复位,有利于早期功能锻炼,术后并发症少,临床疗效满意。Objective To observe the clinical outcome of treatment of complex tibial plateau fiactme via modified inverted ＂ L-shaped＂ approach. Methods From April 2013 to April 2017, 19 patients with complex tibial plateau fiactmes were treated via a modified three-window （posterior medial window, posterior lateral window-, and anterior medial window-） , improved medial inverted ＂ L＂ approach. The dmation of operation, fiactme healing and healing time of each patient, as well as postoperative complications, were recorded. Knee function assessment[ Amer- ican Special Surgery Hospital knee joint score （HSS score） ] and tibial plateau fiacture reduction radiological assess- ment （ Rasmussen score ） were used in postoperative follow-up. Results The mean dmation of opeartion in all pa- tients was （137.3 _＋ 32.4）rain. Bone healing could be seen in all patients, and the average healing time was （15.5 _＋ 3.7 ）weeks. All 19 patients were followed up for （23.1 _＋ 4.2 ）months. The HSS score of the last follow-up was 71-100 points, with a good and excellent rate of 94.7% , and the Rasmussen score was 6-18 points, with a good and excellent rate of 89.5%. There was incision rupture （ -t = 1 ）, necrosis of incision skin margin （ -t = 1 ）, numb- ness of the calf （ - = 1 ） and loosening of the intemal fixation screw （ -t = 1 ）, which, however, did not affect fiactme healing. Conclusion In the treatment of complex tibial plateau flacture, modified inverted ＂ L-shaped＂ approach can provide excellent exposure to bone fiactme and ensure accurate reduction of the fiacture, which maximizes the anatomical reduction of the joint surface. It was conducive to make early functional exercises. In addition, there werefewer complications, and the treatment effect was remarkable.

关 键 词：胫骨骨折 外科手术 手术入路 治疗结果 

分 类 号：R683.42[医药卫生—骨科学]