膝关节后内侧入路和后外侧入路手术治疗胫骨平台后侧骨折的效果及对患者JOA评分的影响  

Effect of Posterior Medial Approach and Posterior Lateral Approach to Posterior Tibial Plateau Fracture and its Effect on JOA Scores

作　　者：吴小宝 陈晓君 张利萍 汤培 WU Xiaobao;CHEN Xiaojun;ZHANG Liping;TANG Pei(Department of Orthopedics,the 92nd Hospital of PLA,Nanping Fujian 353000,China)

机构地区：[1]解放军第九二医院骨伤科,福建南平353000

出　　处：《解放军预防医学杂志》2018年第11期1419-1421,1444,共4页Journal of Preventive Medicine of Chinese People's Liberation Army

基　　金：福建中医药大学校管科研课题(No.XB2018088)

摘　　要：目的探讨膝关节后内侧入路和后外侧入路手术治疗胫骨平台后侧骨折的效果及对患者JOA评分的影响。方法选取2017年5月-2018年5月我院收治的胫骨平台后侧骨折患者168例为研究对象,按照随机数字表法将其分为研究组与对照组,各84例。对照组应用膝关节后内侧入路方案治疗,研究组应用膝关节后内侧入路联合后外侧入路方案治疗。对两组患者术后JOA评分、Lysholm评分、随访1年后的膝关节恢复优良率及骨折复位效果进行对比。结果两组患者治疗前疼痛评分、行走功能评分、稳定性评分等均无明显差异(P>0.05),治疗后,皆有所改善,但研究组各项评分均高于对照组(P<0.05);术后3个月皆行Lysholm评分,研究组膝关节跛行、承受能力、疼痛、上下楼能力、关节肿痛、下蹲起立、总分数等均高于对照组(P<0.05);术后随访1年,研究组膝关节恢复优良率为95.3%,对照组为71.4%,研究组明显高于对照组(P<0.05);术后随访1年,研究组膝关节骨折复位优良率为94.0%,对照组为78.6%,研究组明显高于对照组(P<0.05)。结论膝关节后内侧入路联和后外侧入路手术治疗胫骨平台后侧骨折,有利于膝关节功能恢复和骨折定位,效果较佳,临床上应进一步推广应用。Objective To investigate the therapeutic effect of the posterior medial approach and posterior lateral approachto posterior tibial plateau fractures and the effect on JOA scores of patients. Methods A total of 168 patients with posterior tibialplateau fractures admitted to our hospital between May 2017 and May 2018 were enrolled. According to the random number tablemethod, they were divided into study group and control group, with 84 cases in each. The control group was treated with the posterior medial approach to knee joints, while the study group was treated with the posterior medial approach and posterior lateralapproach. The postoperative JOA scores, Lysholm scores, excellent knee recovery rate and fracture reduction after one-year follow-up were compared. Results There was no significant difference in pre-treatment pain scores, walking function scores or stability scores between the two groups （ P 〉 0. 05）. After treatment, the scores were improved, especially in the study group（P〈0. 05）. Lysholm scores were calculated 3 months after operation. The total scores of knee joints, tolerance, pain, ability togo up and down, joint swelling and pain, and squat standing were higher in the study group than in the control group （P〈0. 05）.After a year of follow-up, the excellent rate of knee joint recovery was 95. 3% in the study group and 71. 4% in the controlgroup. After the follow-up of one year, the excellent rate of knee fracture reduction in the study group was 94. 0%, compard to78. 6% in the control group. This rate was significantly higher in the study group than in the control group （P〈0. 05）. Conclusion The posterolateral medial approach and posterolateral approach to posterior tibial plateau fractures can promote the recoveryof knee joint function and fracture location. The effect is better and should be used more widely.

关 键 词：膝关节 后内侧入路手术 后外侧入路手术 胫骨平台后侧骨折 

分 类 号：R683.4[医药卫生—骨科学]