后内侧入路治疗胫骨平台后柱骨折21例疗效分析

Clinical analysis of posterior medial approach for treatment of tibial plateau posterior column fracture

关键词:  胫骨平台骨折  三柱分型  后内侧入路

Key words:  plateau fracture  “three-column” classification  posterior medial approach

摘要:

目的　探讨在漂浮体位下通过后内侧入路治疗胫骨平台后柱骨折的临床疗效。方法　选取2013—2016年21例胫骨平台后柱骨折患者。其中男18例，女3例，年龄34~68岁，平均（47.86±8.60）岁，其中Schatzker分型中Ⅰ型4例，Ⅱ型5例，Ⅲ型8例，Ⅳ型1例，Ⅴ型2例，Ⅵ型1例，所有患者均合并后柱骨折，均采用后内侧倒L形路治疗后柱骨折，疗效采用HSS评分系统对患肢恢复情况进行评价。结果　21例均获得随访。随访时间平均为（11.23±3.14）个月。术后下肢力线及关节面高度恢复满意。术后无内固定失效、关节僵硬等并发症发生。其中20例患者末次随访膝关节屈伸度可达到5°~120°。HSS评分平均为85.36±9.13。按照HSS评分分级标准，优17例，良3例，差1例。优良率为95.2%。结论　后内侧入路治疗胫骨平台后柱骨折可有效恢复下肢功能，减少术后并发症的发生，是一种有效的治疗方法。

Abstract:

ObjectiveTo investigate the clinical result of posterior medial approach for treatment of tibial plateau posterior column fracture.MethodsFrom 2013 to 2016，21 cases with tibial plateau fracture were enrolled in the study, including Schatzker classification Type Ⅰ 4 cases, type Ⅱ 5 cases，Type Ⅲ 8 cases, type Ⅳ 1 case, type Ⅴ 2 cases, and type Ⅵ 1 case. All cases were posterior column fracture according to “three-column” classification systems and treated through posterior medial approach. The therapeutic effect was evaluated by the knee functional therapy assessment method of HSS.ResultsAll patients were followed up for（11.23±3.14） months. According to HSS grading standards, 17 patients got excellent result，3 good，and 1 bad. After surgery, the good and excellent results were 95.2%.ConclusionsPosterior medial approach for the treatment of tibial plateau posterior column fractures, which can maximize the recovery of lower limb function, is an effective treatment.