漂浮体位下改良的扩大外侧入路治疗胫骨平台外侧双柱骨折  

A Modified Extended Lateral Approach to Manage the Lateral Double Column Fracture of the Tibial Plateau under the Floating Position

作　　者：徐晨阳 徐静磊 马献忠 赵志强 XU Chen-yang;XU Jing-lei;MA Xian-zhong;ZHAO Zhi-qiang(Pelvic Acetabulum Department,Henan Luoyang Orthopedic Hospital(Zhengzhou Hospital Area of Henan Orthopedic Hospital),Zhengzhou 450000,Henan Province,China)

机构地区：[1]河南省洛阳正骨医院(河南省骨科医院郑州院区)骨盆髋臼科创伤外科,河南郑州450000

出　　处：《罕少疾病杂志》2024年第11期124-126,共3页Journal of Rare and Uncommon Diseases

基　　金：河南省中医药拔尖人才培养项目专项课题(2022ZYBJ24)。

摘　　要：目的探讨漂浮体位下改良的扩大外侧入路治疗胫骨平台外侧双柱骨折的临床疗效及安全性。方法统计2020年1月至2022年10月,我院采用漂浮体位下改良的扩大外侧入路结合钢板复位内固定治疗按照三柱分型为胫骨平台外侧双柱骨折患者36例。术后对骨折复位情况进行评价,术后1天及1.5个月、3个月、半年、1年随访X线片,了解胫骨平台骨折临床愈合情况及患肢功能的恢复状况。术后1年复查通过X线片测量术侧及对侧胫骨平台内翻角(TPA)及后倾角(PA)。同时采用美国纽约特殊外科医院的评分系统(HSS评分系统)对患侧膝关节功能进行评分,评价膝关节功能恢复情况。结果36例患者全部顺利完成手术,手术时间61-96min,中位数79min;术中出血量50m L-400m L,中位数200m L。术后行X线及CT检查,Rasmussen放射学评分14-18分,平均(17.0±2.0)分,优28例,良8例,优良率100%。36例患者均获得了完整随访,患者随访时间13-32月,中位数17个月;所有骨折均愈合,愈合时间12周-28周,中位数20周。末次随访时,患者术侧膝关节活动度为100°-150°,中位数120°;术后12个月,术侧膝关节的后倾角及内翻角与术后第一天相比较,差异无统计学意义(均P>0.05)。HHS评分为85-98分,中位数93分,均为优。术后并发切口延迟愈合1例,经换药VSD覆盖后2周切口正常愈合。结论改良的扩大外侧入路治疗胫骨平台外侧双柱骨折,骨折复位固定优,临床愈合良好,术后膝关节功能评分优,同时并发症较少。Objective To explore the clinical efficacy and safety of a modified expanded lateral approach in the treatment of lateral double column fracture of the tibial plateau under the floating position.Methods From January 2020 to October 2022,36 patients with lateral double column fracture of the tibial plateau under the floating position classified according to three column classification in our hospital who were treated with a modified expanded lateral approach combined with steel plate reduction and internal fixation were counted.The fracture reduction was evaluated after surgery,and 1 day after the operation and 1.5,3,6,12 months follow-up x-rays to understand fracture healing and functional recovery.12 months after the operation,the tibial plateau varus angle(TPA)and posterior inclination angle(PA)of the affected side and the healthy tibia platform were measured.At the same time,the United States Special Surgery Hospital Knee Joint Scoring System(HSS)of was used to evaluate the recovery of knee function.Results All patients successfully completed the operation,with 61-96 min and median 79min,and intraoperative bleeding 50mL-400mL,median 200mL.X-ray and CT examination were performed after the operation,and the Rasmussen radiology score was 14-18 points,with an average score of(17.0±2.0)points.28 cases were excellent,8 cases were good,and the excellent and good rate was 100%.36 patients were fully followed up,with a follow-up time of 13-32 months and a median of 17 months.All fractures healed,with a healing time of 12-28 weeks and a median of 20 weeks.In the last follow-up,the patient's knee joint activity was 100°-150°,with a median of 120°.There was no statistically significant difference in the posterior inclination angle and varus angle of the affected knee joint 12 months after surgery compared to the first day after surgery(all P>0.05).The HHS score was 85-98 points,with a median score of 93 points,both of which were excellent.1 case with delayed healing of concurrent incision after surgery,and the incisio

关 键 词：改良的扩大外侧入路 胫骨平台 外侧双柱骨折 

分 类 号：R816.8[医药卫生—放射医学]