改良后侧入路治疗胫骨平台后侧骨折疗效观察

Clinical observation of modified posterior approach for the treatment of posterior tibial plateau fracture

关键词:  胫骨平台  后髁骨折  后侧入路  支撑钢板

Key words:  [Key words]　tibial plateau  posterior plateau fracture  posterior approach  buttress plate

摘要:

[摘要]　目的　探讨经改良后侧入路治疗胫骨平台后侧骨折的疗效。　方法　自2011年7月至2014年4月大连医科大学附属第二医院确诊并收治了胫骨平台后侧骨折21例，其中男13例，女8例；年龄39～55岁（平均45.8岁）；其中17例为单纯后柱骨折，4例合并内侧或外侧柱骨折，单纯后柱骨折中8例患者为后内侧骨折，5例患者为后外侧骨折，4例患者同时累及后内和后外侧。用改良后侧手术入路术式切开复位内固定治疗胫骨平台后侧骨折。本组患者中有4例合并内侧柱或者外侧柱骨折，取“漂浮”体位，采用前内或者前外侧联合入路。采用DeCoster 提出的评价方法对术后即刻复位情况进行评价。采用美国特种医院 （the hospital for special surgery，HSS）膝关节评分标准对术后12个月患膝功能进行分析。　结果　21例患者手术切口愈合良好；术后即刻X线复查，骨折复位良好。本组患者均获得长时间随访，随访时间12～22（平均16.2）个月。患者10～12周开始部分负重锻炼，骨折愈合后可逐渐完全负重锻炼，骨折愈合时间12～15（平均13）周，无骨延迟愈合、不愈合、内固定失效、关节僵硬，无膝关节内、外翻畸形等并发症。术后12个月复查膝关节的屈伸度平均为5°～130°，根据美国特种医院膝关节评分平均87.2分（65～94分），优良率为90.5%。　结论　经改良后侧入路治疗胫骨平台后髁骨折操作简单、骨折暴露充分，固定切实可靠，术后可早期功能锻炼，并发症少，临床效果满意。

Abstract:

[Abstract] Objective To investigate the effect of modified posterior approach in the treatment of posterior tibial plateau fracture. Methods From July 2011 to April 2014, 21 cases of posterior tibial plateau fracture were diagnosed and treated at the Second Affiliated Hospital of Dalian Medical University, including 17 cases of simple posterior fracture of the tibial plateau and 4 cases of posterior fracture of the tibial plateau with lateral column fracture or medial column fracture. There were 8 patients of postermedial tibial plateau fracture, 5 patients of posterolateral tibial plateau fractures, 4 patients involved with both posteromedial fracture and posterolateral fracture. There were 13 males and 8 females with an average age of 45.8 years (range, 39-55 years). The doctors selected the appropriate choice of the modified posterior approach operation technique for the treatment of posterior tibial plateau fracture. There were 4 cases of posterior fracture of the tibial plateau with lateral column fracture or medial column fracture in this group and used the joint operation approach through the "floating" posture. Reduction was tested immediately after operation by X-ray according to DeCoster's method. The function of knees was evaluated using HSS score system at 12 months post-operation. Results All wounds achieved healing by first intention. X-ray showed that all patients was achieved reduction of anatomy immediately after operation. All patients were followed up 12-23 months (mean,16.2 months). The patient began partial weight-bearing exercise after 10-12 weeks. After fracture healing, the patients could do full weight-bearing exercise gradually. The average fracture healing period was 13 months (range, 12-15 months). No related complication occurred, such as nonunion, delayed union, failure in internal fixation, ankylosis, malunion, varus and valgus deformity. The average ROM (range of motion) of the affected knee joints was 5-130 at 12 mouths postoperatively. The average HSS score was 87.2 (range 65-94, the rate of "excellent and good" was 90.5). Conclusion Internal fixation through modified posterior approach for tibial plateau fracture has advantages of less surgery trauma, simple operation, fully exposed, fixed immobilization and received early postoperative rehabilitation. The clinical results are satisfied.