前外侧入路治疗SchatzkerⅡ型和SchatzkerⅤ/Ⅵ型骨折的临床疗效比较  

Comparison of clinical results of extended anterolateral approach in treating simple(Schatzker typeⅡ)and complex(Schatzker typeⅤ/Ⅵ)tibial plateau fractures

作　　者：朱轶 田守进[1] 王创利[1] 张金坤[1] 刘苏[1] 葛建飞[1] ZHU Yi;TIAN Shou-jin;WANG Chuang-li;ZHANG Jin-kun;LIU Su;GE Jian-fei(Department of Orthopaedics,Zhangjiagang Hospital,Suzhou University,Zhangjiagang,Jiangsu,215600,China)

机构地区：[1]苏州大学附属张家港医院骨科,江苏215600

出　　处：《中国骨与关节杂志》2021年第12期932-937,共6页Chinese Journal of Bone and Joint

摘　　要：目的探讨采用扩展前外侧入路治疗SchatzkerⅡ型和SchatzkerⅤ/Ⅵ型骨折的临床疗效差异。方法回顾性分析2013年1月至2018年5月我院骨科收治的胫骨平台骨折患者,根据Schatzker分型分为SchatzkerⅡ型(A组)和SchatzkerⅤ/Ⅵ型(B组)。比较两组患者骨折特点、手术情况及术后功能,并做统计分析。结果本组共80例,A组44例,B组36例,平均随访时间为31(15~47)个月。手术时间及术中失血量A组明显少于B组(P<0.05);骨折愈合时间相比差异无统计学意义(P>0.05);术后1年膝关节Rasmussen评分A组为27.2分,B组为23.6分,组间比较差异无统计学意义(P>0.05);术后1年膝关节活动度A组(112.8°),优于B组(104.8°)(P<0.05)。骨折复位的优良率A组为93.2%,B组为80.6%,两组相比差异无统计学意义(P>0.05);而A组复位率为81.5%,明显优于B组的32.4%(P<0.05)。术后A组2例切口愈合不佳,后通过伤口护理好转。B组1例切口感染,经清创及加强抗生素治疗后愈合。结论扩展前外侧入路治疗SchatzkerⅡ型和SchatzkerⅤ/Ⅵ型骨折可取得较满意的临床效果。SchatzkerⅡ型骨折手术难度小,复位满意,内固定更确切。Objective To compare the clinical effects of extended anterolateral approach in the treatment of simple(Schatzker typeⅡ)and complex(Schatzker typeⅤ/Ⅵ)posterolateral tibial plateau fracture.Methods Clinical data of patients with tibial plateau fracture,from January 2013 to May 2018,were retrospectively analyzed.Patients with fracture Schatzker typeⅡwere divided to Group A and patients with fracture Schatzker typeⅤ/Ⅵwere divided into Group B.Fracture characteristics,operation information and postoperative functions were recorded and analyzed.Results A total of 80 patients were analyzed in the study,including 44 patients in Group A and 36 patients in Group B.All patients were followed up for 15 to 47 months with a median of 31 months.The operation time and intraoperative blood loss were significantly less in Group A(P<0.05);no significant differences in bone healing time were detected(P>0.05);the Rasmussen score was 27.2 in Group A and 23.6 in Group B,no significance was detected(P>0.05);the range of motion(ROM)in Group A(112.8°)was wider than that in Group B(104.8°)(P<0.05).The excellent and good rate of reduction was 93.2%in Group A and 80.6%in Group B without significant differences detected(P>0.05).The reduction rate in Group A(81.5%)was significantly higher than that in Group B(32.4%)(P<0.05).Poor wound healing in 2 patients of Group A was improved after wound care.Wound infection in 1 patient of Group B was controlled after debridement and antibiotics application.Conclusions The extended anterolateral approach could obtain satisfactory clinical results in treating simple(Schatzker typeⅡ)and complex(Schatzker typeⅤ/Ⅵ)tibial plateau fractures with easier operation,good reduction and reliable fixation.

关 键 词：骨折固定术 内 骨折愈合 感染 

分 类 号：R683.4[医药卫生—骨科学]