经前外侧扩展入路治疗胫骨平台后外侧骨折的效果分析  

Anterolateral extension approach for posterolateral tibial plateau fractures

作　　者：刘刚 吕永祥 李子昂 朱自强 Liu Gang;Lyu Yongxiang;Li Zi’ang;Zhu Ziqiang(Department of Trauma Orthopedics,the Second Affiliated Hospital of Xuzhou Medical University,Xuzhou,Jiangsu Province 221000,China)

机构地区：[1]徐州医科大学第二附属医院创伤骨科,江苏徐州221000

出　　处：《创伤外科杂志》2024年第1期49-53,共5页Journal of Traumatic Surgery

基　　金：徐州市2022年推动科研创新专项项目(KC22202)。

摘　　要：目的观察经前外侧扩展入路在胫骨平台后外侧骨折中的应用效果。方法回顾性分析2018年12月—2021年12月徐州医科大学第二附属医院创伤骨科收治的胫骨平台后外侧骨折患者62例,男性39例,女性23例;年龄24~79岁,平均55.9岁。病程11~14d,平均12.1 d。依据治疗方案不同将患者分为改良组(33例)和传统组(29例),改良组经前外侧扩展入路治疗,传统组经传统前外侧入路治疗。比较两组患者手术时间、出血量及住院时间等围术期指标及随访过程中影像学、膝关节功能评分。结果患者均获随访12~18个月,平均13.5个月。改良组手术时间、出血量均显著优于传统组(86.89±1.32)min vs.(96.97±1.79)min、(94.70±6.27)mL vs.(218.59±8.47)mL(P<0.05)。两组患者住院时间比较差异无统计学意义[(12.70±1.27)d vs.(13.59±2.47)d,P>0.05]。改良组完全负重时间、末次随访Harris髋关节功能评分(HSS)和关节活动度(ROM)评分显著优于传统组(100.25±8.33)d vs.(150.24±9.42)d、(94.57±0.47)分vs.(88.39±0.46)分、(124.42±0.46)分vs.(115.39±0.41)分(P<0.05)。两组患者Rasmussen评分比较差异无统计学意义[(17.19±0.58)分vs.(15.64±0.49)分,P>0.05],末次随访显示,改良组胫骨平台角、后倾角显著大于传统组(88.56±1.63)°vs.(85.54±1.39)°、(12.84±0.48)°vs.(11.02±0.42)°(P<0.05)。结论经前外侧扩展入路治疗胫骨平台后外侧骨折能够改善显露,缩短手术时间,提高手术质量,手术安全高效,促进患者术后膝关节功能恢复,值得临床进一步推广使用。Objective To assess the effect of extended anterolateral approach in the treatment of posterolateral tibial plateau fractures.Methods From Dec.2018 to Dec.2021,62 patients with posterolateral tibial plateau fractures and managed in our hospital were retrospectively analyzed,including 39 males and 23 females.The age ranged 24-79 years with an average of 55.9 years.The course of disease was 11-14(mean 12.1)d.According to the surgical approaches,patients were divided into modified group(extended anterolateral approach,n=33)and traditional group(anterolateral approach,n=29).The operation time,intraoperative blood loss,length of hospital stay,imaging findings and knee function scores were compared between the two groups.Results All patients were followed up for a mean period of 13.5(range 12-18)months.Compared with the traditional group,the modified group revealed much shorter operation time(min,86.89±1.32 vs.96.97±1.79),much less blood loss(mL,94.70±6.27 vs.218.59±8.47,both P<0.05)and similar length of hospital stay(d,12.70±1.27 vs.13.59±2.47,P>0.05).The full weight bearing time(d,100.25±8.33 vs.150.24±9.42),last follow-up Harris hip score(94.57±0.47 vs.88.39±0.46)and range of motion score(124.42±0.46 vs.115.39±0.41)were significantly better in the conventional group,except for the Rasmussen score(17.19±0.58 vs.15.64±0.49,P>0.05).Moreover,the tibial plateau angle and the posterior slope angle were much larger in the modified group(88.56°±1.63°vs.85.54°±1.39°,12.84°±0.48°vs.11.02°±0.42°,both P<0.05).Conclusion Extended anterolateral approach for posterolateral tibial plateau fractures can enlarge the surgical exposure,shorten the operation time,improve surgery quality and safety,and promote postoperative knee functional recovery,and is worthy of clinical application.

关 键 词：胫骨平台骨折 骨块 开放复位内固定 手术入路 经前外侧扩展入路 

分 类 号：R683.42[医药卫生—骨科学]