膝关节前外侧入路联合后内侧入路治疗胫骨后外侧平台骨折的近期疗效观察  

The recent efficacy observation of anterolateral approach combine with posteromedial approach in the treatment of posterolateral tibial plateau fractures

作　　者：姚龚 林文 李敏[1] 张鹏翼[1] 冷云飞[1] 于沈敏 Yao Gong;Lin Wen;Li Min(Department of Orthopedics,the Hospital of Huangpu District,Shanghai,200002,China)

机构地区：[1]上海市黄浦区中心医院骨科,上海200002

出　　处：《生物骨科材料与临床研究》2018年第6期29-31,共3页Orthopaedic Biomechanics Materials and Clinical Study

摘　　要：目的探讨膝关节前外侧入路联合后内侧入路治疗胫骨后外侧平台骨折的近期疗效。方法回顾性分析2013年1月至2017年8月在我院治疗的胫骨后外侧平台骨折患者共21例,均采用前外侧入路联合后内侧入路进行手术治疗。其中男性12例,女性9例;平均年龄(45.8±4.3)岁。根据骨折AO分型,均为B型骨折,其中B1.1型8例、B2.1型6例、B2.2型4例、B3.1型3例;按三柱分型则均为外侧柱+后柱骨折。术后进行随访,并采用美国特种外侧医院(HSS)膝关节评分评价患者关节功能情况。结果 21例病例手术平均时间为(141±10.2) min,术中平均出血量(391±13.4)mL。术后随访6～8个月。按HSS膝关节功能评分标准,优12例,良6例,可2例,差1例,优良率85.7%。2例患者出现前外侧伤口感染,经积极抗炎治疗后好转,并发症率9.52%。结论膝关节前外侧入路结合后内侧入路治疗胫骨后外侧平台骨折手术视野清晰,内固定可靠且符合生物力学,术后关节功能满意。Objective To observe the recent efficiency of anterolateral approach combined with postermedial approach in the treatment of posterolateral tibial plateau fractures. Methods From Jan 2013 to Aug 2017, 21 comminuted fractures were treated in our hospital, all cases were treated with surgery using anterolateral approach combined with postermedial approach. There were 12 males and 9 females, with a mean age of(45.8±4.3) years. By AO classification, all cases were type B, there are 8 cases of type B1.1, 6 cases of type B2.1, 4 cases of type B2.2 and 3 cases of type B3.1; by "three-column" concept, all cases were lateral column plus posterior column. All patients were monitored and the knee function of the patients was evaluated by the Hospital for Special Surgery(HSS) score. Results The average operation time was(141±10.2) min, the average blood loss were(391±13.4) mL. 21 patients were followed up for an average duration of 6 to 8 months. According to HSS knee function score criteria, excellent in 12 cases, good in 6 cases, fair in 2 cases, poor in 1 case, the excellent and good rate was 85.7%. 2 patients had anterolateral wound infection, improved by anti-inflammatory therapy. The rate of complications was 9.52%. Conclusion The knee anterolateral approach combined with posterolateral approach in the treatment of posterolateral tibial plateau fractures have a clear vision of surgery.The internal fixation is reliable and conformed to biomechanics. The postoperative joint function is satisfactory.

关 键 词：胫骨骨折 膝关节 三柱理论 内固定 

分 类 号：R681.8[医药卫生—骨科学]