后内侧入路内固定治疗胫骨平台后柱骨折
发布时间：2018-08-08 17:17
【摘要】：目的探讨切断腓肠肌内侧头后内侧入路内固定治疗胫骨平台后柱骨折的手术方法和评价其临床疗效。方法对大连医科大学附属第一医院创伤骨科自2013年7月至2016年9月采用后内侧入路内固定治疗且随访资料完整的14例胫骨平台后柱骨折患者进行回顾性分析,其中男11例,女3例;年龄37-68岁,平均年龄(50.4±9.6)岁;AO/OTA分型:41-B3.1 型 1 例,41-B3.3 型 6 例,41-C1.2 型、41-C3.2 型各 1 例,41-C3.1型2例,41-C3.3型3例;罗从风三柱分型:三柱骨折5例,后柱并外侧柱双柱骨折3例,后柱并内侧柱双柱骨折4例,仅后柱2例;后柱骨折形态:单纯后内柱骨折4例,后内柱劈裂合并后外柱塌陷骨折10例;Schatzker分型:Ⅱ型1例,Ⅳ型6例,V型4例,Ⅵ3例。损伤原因:交通车祸伤6例,高处坠落伤2例,行走摔伤5例,打架殴伤1例。14例患者均为单侧闭合新鲜骨折。受伤至手术时间2-12天,平均(5.6±2.3)天。其中7例涉及后柱骨折采用膝关节后内侧入路并切断腓肠肌内侧头予以治疗(作为观察组);另外7例涉及后柱骨折采用传统后内侧入路,即未予以切断腓肠肌内侧头的治疗方式(作为对照组);部分关节面塌陷严重者采用自体髂骨植骨或异体骨植骨。记录两组骨折愈合时间,测量术后与末次随访的胫骨平台后倾角、内翻角,评价术后Rasmusen解剖学评分及末次随访的HSS膝关节功能评分,比较两种不同手术入路的临床疗效。选用SPSS 19.0版统计学软件对收集的数据进行分析处理。结果术中探查后交叉止点断裂2例,外侧半月板受损2例,均予修补,胫骨向外上脱位合并游离骨块脱入股骨髁外侧嵌顿1例。术后手术切口均为一期愈合,无重要血管、神经的损伤。14例患者获得8-12个月随访,平均(11.4±1.5)月。均获得骨性愈合,骨折愈合时间12-16周,平均(14.7±1.3)周。至末次随访时未发生明显复位丢失、内固定物松动、感染、关节僵硬、畸形愈合、创伤性关节炎等并发症。观察组与对照组的平均骨折愈合时间分别为(14.3士 1.4)周和(15.1±1.0)周,两组比较差异无统计学意义(P0.05);两组术后与末次随访胫骨平台内翻角及后倾角、术后Rasmusen评分、随访末次HSS评分等比较差异均无统计学意义(P0.05)。结论后内侧入路内固定治疗胫骨平台后柱骨折是一种安全,实用的手术入路。由于有鹅足及腓肠肌内侧头的解剖位置原因,以往后内侧入路不能很好对胫骨整个后柱进行显露,钢板很难放置于后柱中央区进行有效的内固定。而切断腓肠肌内侧头入路能很好暴露整个胫骨平台后柱,利于骨折解剖复位及内固定物安置,与传统后内侧入路相比较不会增加手术并发症,也不会影响骨折的愈合时间。
[Abstract]:Objective to investigate the surgical treatment of posterior column fracture of tibial plateau with medial gastrocnemius muscle transection and posterior medial fixation and to evaluate its clinical effect. Methods from July 2013 to September 2016, 14 patients with posterior column fracture of tibial plateau who were treated with posterior medial internal fixation from July 2013 to September 2016 were retrospectively analyzed. There were 3 females, 37-68 years old, with an average age of (50.4 卤9.6) years according to AOP / OTA classification: 1 case of type 41-B3.3, 6 cases of type 41-B3.3, 1 case of type 41-C3.2, 2 cases of type 41-C3.1, 3 cases of type 41-C3.3, and 3 cases of three-column fracture, and 3 cases of posterior column and lateral column fracture. There were 4 cases of posterior column and medial column fracture, 4 cases of posterior column fracture, 10 cases of posterior column fracture combined with collapse fracture of posterior and outer column: type 鈪，
本文编号：2172474
[Abstract]:Objective to investigate the surgical treatment of posterior column fracture of tibial plateau with medial gastrocnemius muscle transection and posterior medial fixation and to evaluate its clinical effect. Methods from July 2013 to September 2016, 14 patients with posterior column fracture of tibial plateau who were treated with posterior medial internal fixation from July 2013 to September 2016 were retrospectively analyzed. There were 3 females, 37-68 years old, with an average age of (50.4 卤9.6) years according to AOP / OTA classification: 1 case of type 41-B3.3, 6 cases of type 41-B3.3, 1 case of type 41-C3.2, 2 cases of type 41-C3.1, 3 cases of type 41-C3.3, and 3 cases of three-column fracture, and 3 cases of posterior column and lateral column fracture. There were 4 cases of posterior column and medial column fracture, 4 cases of posterior column fracture, 10 cases of posterior column fracture combined with collapse fracture of posterior and outer column: type 鈪，
本文编号：2172474
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