胫骨平台后外侧柱骨折扩大外侧入路内固定增强力学稳定性及膝关节功能  

Adopting expanded lateral approach to enhance the mechanical stability and knee function for treating posterolateral column fracture of tibial plateau

作　　者：林旺 王盈盈 郭卫中 袁翠华 许胜贵 张申申 林成寿 Lin Wang;Wang Yingying;Guo Weizhong;Yuan Cuihua;Xu Shenggui;Zhang Shenshen;Lin Chengshou(Mindong Hospital Affiliated to Fujian Medical University,Fuan 355000,Fujian Province,China)

机构地区：[1]福建医科大学附属闽东医院,福建省福安市355000

出　　处：《中国组织工程研究》2021年第24期3826-3831,共6页Chinese Journal of Tissue Engineering Research

基　　金：福建省自然科学基金资助项目(2012J01438),项目负责人:林成寿。

摘　　要：背景:胫骨平台后外侧柱骨折是创伤骨科的难点,手术入路的选择是治疗的关键步骤之一,但目前对于入路选择尚无一个被多数学者接受的公认选择标准。目的:调查胫骨平台后外侧柱骨折的发病特点及发生率,探讨扩大外侧切口在后外侧柱骨折中的应用前景。方法:通过国际疾病代码从2009年7月至2019年3月福建医科大学附属闽东医院收治的患者病历数据库筛选出胫骨平台骨折手术患者,通过PACS系统回顾性复习患者骨折部位的影像学资料,采用Schatzker法及罗从风三柱法分别对骨折进行分类,后柱分为后内侧柱和后外侧柱,将游离后外侧柱骨折定义为后外侧柱主骨折块与后内侧柱及外侧柱主体不相连。调查后外侧柱骨折的患病特点,采用扩大外侧入路前瞻性治疗其中21例移位游离后外侧柱骨折患者。结果与结论:①共426例患者入选,427个胫骨平台骨折;涉及后外侧柱骨折有267个,游离后外侧柱126例,外侧柱+平台关节面下4 cm以内的移位游离后外侧柱骨折73例;②采用扩大外侧切口治疗的21例患者均获骨性愈合;③提示扩大外侧入路适用于外侧柱+平台关节面下4 cm以内的游离移位后外侧柱骨折,可单用于SchatzkerⅡ型骨折,或联合其他切口治疗SchatzkerⅤ,Ⅵ型骨折,该入路适用的患者约占全部平台骨折的17%,具有较好的应用前景。BACKGROUND:The posterolateral column fracture on tibial plateau is the difficult point of traumatic orthopedics.The choice of operative approach is one of critical steps of treatment.However,nowadays there is not an acknowledged standard of choosing approach to be accepted by most scholars.OBJECTIVE:To investigate the characteristics and the incidence rate of posterolateral column fracture on tibial plateau,discuss the application prospect on adopting expanded lateral approach to treat the posterolateral column fracture.METHODS:The data of the patients with tibial plateau fractures were screened by International Classification of Disease Code from an electronic medical records database of the patients hospitalized in Mindong Hospital Affiliated to Fujian Medical University between July 2009 and March 2019.The Picture and Archiving Communication System was used to review the radiographic record on all patients’tibial plateau fractures.Schatzker classification and threecolumn classification was respectively used to classify the fracture types.The posterior column was divided into posterolateral and posteromedial column.The“independent posterolateral column fracture”was defined as a fracture whose main fragment disconnected with lateral and posteromedial columns’main body.The fracture characteristics of the posterolateral column were researched.The expanded lateral approach was adopted to treat 21 cases with displaced independent posterolateral column fractures.RESULTS AND CONCLUSION:(1)Totally 426 patients were enrolled,including 427 tibial plateau fractures.The posterolateral column fractures were involved in 267 cases and the“independent posterolateral column fractures”were involved in 126 cases.Totally 73 cases had lateral column fracture+displaced independent posterolateral column fracture within 4 cm under the articular surface on tibial plateau.(2)Twenty-one cases adopted expanded lateral approach obtained bony union.(3)It is concluded that expanded lateral approach suits lateral column+displaced

关 键 词：胫骨平台 后外侧柱 骨折 扩大外侧入路 骨性愈合 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学]