两种入路治疗后外侧胫骨平台骨折的疗效  

The efficacy of posterlateral tibial plateau fractures treated with two kinds of operation approaches

作　　者：龚立[1] 王延鹤[1] 孔令超[1] 吕飞飞[1] 成金磊[1] GONG Li;WANG Yan-he;KONG Ling-chao;Lü Fei-fei;CHENG Jin-lei(Dept of Emergency Traumatic Orthopaedics,Binhu Hospital of Hefei First People′s Hospital Group,Hefei,Anhui 230601,China)

机构地区：[1]合肥市第一人民医院集团滨湖医院急诊创伤骨科,安徽合肥230601

出　　处：《临床骨科杂志》2020年第4期575-579,共5页Journal of Clinical Orthopaedics

基　　金：国家卫计委医药卫生科技发展研究中心项目(编号:W2015QJ062)。

摘　　要：目的比较膝关节后外侧纵直形切口入路与膝关节后内侧倒L形切口入路治疗后外侧胫骨平台骨折的临床疗效。方法将51例后外侧胫骨平台骨折患者按切口入路的不同分为观察组(采用膝关节后外侧纵直形切口入路治疗,31例)和对照组(采用膝关节后内侧倒L形切口入路治疗,20例)。比较两组手术时间、术中出血量、术后胫骨外侧平台后倾角、并发症情况。术后12个月采用HSS评分和膝关节活动度评价临床疗效。结果患者均获得随访,时间13~24个月。手术时间及术中出血量观察组短(少)于对照组,差异均有统计学意义(P<0.05)。两组术后均无相关并发症发生。两组胫骨外侧平台后倾角术后3 d、12个月与术前比较差异均有统计学意义(P<0.05),两组间各时间段比较差异均无统计学意义(P>0.05)。术后12个月,HSS评分、膝关节活动度、HSS评分优良率两组比较差异均无统计学意义(P>0.05)。结论膝关节后外侧纵直形切口入路治疗后外侧胫骨平台骨折具有手术时间短、术中出血量少、创伤小、后外侧暴露充分、易复位等优点,是一种较理想的术式。但后外侧胫骨平台骨折涉及干骺端以远及后内侧髁时,建议选择膝关节后内侧倒L形切口入路治疗。Objective To compare the clinical effect of knee joint posterolateral longitudinal straight incision approach and posteromedial inverted L-shaped incision approach for treatment of posterolateral tibial plateau fractures.Methods Fifty-one patients with posterolateral tibial plateau fractures were divided into observation group(31 cases were treated with posterolateral longitudinal straight incision approach)and control group(20 cases were treated with posteromedial inverted L-shaped incision approach)according to different incision approaches.The operative time,intraoperative bleeding volume,postoperative tibial lateral plateau posterior slope angle and complications were compared between the two groups.HSS score and knee range of motion were used to evaluate the clinical efficacy at 12 months after operation.Results All patients were followed up for 13~24 months.The operation time and intraoperative blood loss volume in the observation group were shorter(less)than those of the control group,and the differences had statistical significance(P<0.05).The two groups had no related postoperative complications.Tibial lateral plateau posterior slope angle of the two groups had statistical differences at the postoperative 3 d,12 months,compared with the preoperation(P<0.05);while there was no statistical difference between the two groups(P>0.05).At 12 months after the operation,there were no statistical differences in HSS score,knee range of motion,and excellent and good rate of HSS score between the two groups(P>0.05).Conclusions The knee joint posterolateral longitudinal straight incision approach is an ideal surgical method for treating posterolateral tibial plateau fracture,which have the advantages of short operation time,less intraoperative blood loss volume,less trauma,full exposure of posterolateral site,easy reduction and so on.However,it is suggested that the posterolateral tibial plateau fracture is treated with knee joint inverted L-shaped incision approach,when the fracture involve distal metaphysis and post

关 键 词：后外侧胫骨平台骨折 纵直形切口入路 倒L形切口入路 

分 类 号：R683.42[医药卫生—骨科学] R687.32[医药卫生—外科学]