腓骨头上方入路与膝关节前外侧入路治疗胫骨平台后外侧髁骨折的比较  

Comparison of the Treatment of posterior lateral condylar Fractures of the Tibial Plateau by superior fibular Approach and anterolateral Knee Joint Approach

作　　者：许斌 周江山 詹德平 潘律 过锡敏 储旭东 XU Bin;ZHOU Jiangshan;ZHAN Deping;PAN Lv;GUO Ximin;CHU Xudong(Department of Orthopaedics,Huishan District People's Hospital,Wuxi Jiangsu 214000,China)

机构地区：[1]江苏省无锡市惠山区人民医院骨科,江苏无锡214000

出　　处：《临床研究》2023年第9期1-5,共5页Clinical Research

摘　　要：目的比较腓骨头上方入路和膝关节前外侧入路治疗单纯胫骨平台后外侧髁骨折的临床效果。方法选取2016年3月至2019年12月于无锡市惠山区人民医院接受的单纯胫骨平台后外侧髁骨折72例作为研究对象,计算机随机数字表法分为对照组(n=36)和研究组(n=36)。对照组实施膝关节前外侧入路结合普通钢板进行治疗;研究组实施腓骨头上方入路联合腓骨头上方入路相配套的解剖钢板进行治疗,比较两组术后相关数据,Rasmussen评价结果,术前或术后美国特种外科医院评价量表(HSS)、视觉模拟评分(VAS)和膝关节活动度(ROM)。结果研究组患者手术时间、骨骼愈合时间、住院时间和负重时间短于对照组,术中出血量少于对照组,差异有统计学意义(P<0.05);对照组术后出现关节面塌陷4例,研究组未出现;研究组12个月随访的Rasmussen评分优良率显著高于对照组,差异有统计学意义(P<0.05)。与术前比较,术后3月、6月、12月和末次随访的HSS、VAS评分和ROM评分均显著改善,差异有统计学意义(P<0.05),其中研究组患者(术后3月和术后6月)HSS评分和VAS评分、(术后3月、6月和12月)的ROM显著优于对照组,差异有统计学意义(P<0.05)。结论腓骨头上方入路治疗胫骨平台后外侧髁骨折的疗效优于传统的膝关节前外侧入路,腓骨头上方入路具有解剖简单安全、术后愈合快、膝关节功能康复快和并发症少的优点,且本院自制的配套钢板可以更好的支撑和固定后外侧髁骨折块,更有益于骨愈合,值得临床应用。Objective To compare the clinical efficacy of the superior fibular approach and the anterolateral approach of the knee joint in the treatment of posterior lateral condylar fractures of the tibial plateau.Methods From March 2016 to December 2019,72 cases of simple posterior lateral condylar fracture of the tibial plateau received in Huishan District People's Hospital of Wuxi City were selected as the research objects.They were divided into the control group(n=36)and the study group(n=36)by computer random number table.The control group received treatment through the anterolateral approach of the knee joint combined with ordinary steel plates;The research group implemented a combination of superior fibular approach and anatomical steel plates for treatment.The postoperative data of the two groups,including Rasmussen evaluation results,preoperative or postoperative American Special Surgery Hospital Evaluation Scale(HSS),Visual Analog Scale(VAS),and Knee Joint Range of Motion(ROM)was compared.Results The surgery time,bone healing time,hospitalization time,and weight bearing time of the study group patients were shorter than those of the control group,and the intraoperative bleeding volume was less than that of the control group,with statistically significant differences(P<0.05);There were 4 cases of postoperative joint surface collapse in the control group,but no occurrence in the study group;The excellent and good rate of Rasmussen score in the 12 month followup of the study group was significantly higher than that of the control group,with a statistically significant difference(P<0.05).Compared with preoperative,the HSS,VAS,and ROM scores at 3,6,12 month and the last follow-up were significantly improved,with a statistically significant difference(P<0.05).Among them,the HSS and VAS scores of patients in the study group(3 and 6 months after surgery),as well as the ROM scores(3,6,and 12 months after surgery),were significantly better than those in the control group,with a statistically significant difference(P<0.05).

关 键 词：胫骨平台 单纯后外侧髁骨折 开放复位内固定 腓骨头上方入路 前外侧入路 

分 类 号：R687.3[医药卫生—骨科学]