| 后内侧入路倒L形切口结合重建钢板治疗胫骨平台后髁骨折 |
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投稿时间：2016-07-20
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| 作者 | Author | 单位 | Address | E-Mail |
| 洪锋 |
HONG Feng |
杭州市萧山区中医院骨科, 浙江 杭州 311200 |
Xiaoshan Traditional Chinese Medical Hospital, Hangzhou 311200, Zhejiang, China |
13867151268@sina.cn |
| 王楠 |
WANG Nan |
杭州市萧山区中医院骨科, 浙江 杭州 311200 |
Xiaoshan Traditional Chinese Medical Hospital, Hangzhou 311200, Zhejiang, China |
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| 陈冠军 |
CHEN Guan-jun |
杭州市萧山区中医院骨科, 浙江 杭州 311200 |
Xiaoshan Traditional Chinese Medical Hospital, Hangzhou 311200, Zhejiang, China |
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| 期刊信息：《中国骨伤》2016年，第29卷，第11期，第1027-1032页 |
| DOI：10.3969/j.issn.1003-0034.2016.11.011 |
| 基金项目: |
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中文摘要:
目的：探讨应用后内侧倒“L”形切口结合重建钢板治疗胫骨平台后髁骨折的临床疗效。
方法：自2011年2月至2015年2月，采用后内侧倒“L”形切口直视下，重建钢板固定后髁治疗19例胫骨平台骨折患者，其中男14例，女5例；年龄28~71岁，平均45.5岁。受伤至手术时间6~15 d，平均9.2 d.按Schatzker分型：Ⅱ型6例，Ⅳ型2例，Ⅴ型7例，Ⅵ型4例。按三柱理论分型：内侧柱合并后柱骨折2例，外侧柱合并后柱骨折6例，三柱骨折11例。术前主要临床症状为膝关节肿胀、畸形及活动受限，X线及CT检查完善。术后采用美国特种外科医院膝关节HSS评分评价临床疗效。
结果：术后1例患者出现内后侧切口皮肤感染，加强换药后愈合良好，无神经血管损伤、下肢深静脉栓塞、内固定断裂失效、骨折再移位等其他并发症发生。19例患者均获随访，时间10~24个月，平均12.5个月。随访患者术后定期复查X线片，骨折均Ⅰ期愈合，骨折愈合时间5~11个月，平均8.2个月。HSS评分总分82.1±7.3；优9例，良7例，中2例，差1例。术后3 d与术后1年骨折愈合后胫骨平台内翻角、后倾角、股胫角比较差异均无统计学意义。
结论：采用膝关节后内侧入路倒“L”形切口治疗胫骨平台后髁骨折，显露充分，损伤小，内固定安装方便、有效。重建钢板具有易于塑形、支撑性较强、内植入体积小、费用低廉的优点，配合恰当的术后康复训练，膝关节的结构和功能恢复可以取得满意的临床疗效。 |
| 【关键词】胫骨平台 骨折 骨折固定术,内 手术入路 |
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| Posterior medial approach inverted L-shaped incision combined with reconstruction plate for posterior condylar fracture of tibial plateau |
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ABSTRACT
Objective: To study the clinical therapeutic effects of posterior medial approach inverted L-shaped incision combined with reconstruction plate fixation in treating posterior tibial plateau condylar fracture.
Methods: From February 2011 to February 2015,19 patients that were clearly diagnosed with combined posterior tibial plateau condylar fracture were treated with internal fixation of reconstruction plate through the posterior medial approach L-shaped incision under direct vision,involved 14 males and 5 females with an average age of 45.5 years ranging from 28 to 71 years. The intervals between injury and operation ranged from 6 to 15 days with a mean of 9.2 days. According to Schatzker Classification,there were 6 cases in typeⅡ,2 in type Ⅳ,7 in type Ⅴ,4 in type Ⅵ In accordance with the three-column theory proposed by Luo Congfeng,2 cases were medial column combined with posterior column fracture,6 were lateral column combined with posterior column fracture,and 11 were three-column fracture. The major clinical symptoms before treatment were swelling and deformity of the knee,as well as limitation of motion. X-ray and CT examination were completed. The American Hospital for Special Surgery score(HSS) was used to evaluate clinical effect.
Results: One case developed skin infection in the posteromedial incision postoperatively,but other complications,such as neurovascular injury,deep venous thrombosis of lower limb,cracking and failure of internal fixation,and fracture re-displacement were not seen. The patients were followed up for an average of 12.5 months (10 to 24 months). The fracture healing time ranged from 5 to 11 months with a mean of 8.2 months. According to HSS,the total score was 82.1±7.3,9 patients got an excellent result,7 good,2 poor and 1 bad. Regular postoperative re-check X-ray indicated that all fracture showed stage I healing. The difference was not significant on varus angle,post-dip angle and femorotibial angle between 3 days and 1 year after operaiton.
Conclusion: Treating the posterior tibial plateau condylar fracture through the posterior medial approach L-shaped incision of the knee rendered sufficient exposure,little injury,as well as convenient and effective installation of internal fixation. Reconstruction plate possessed the advantages of good plasticity,strong supportability,small implant volume,together with low cost;and the structural and functional recovery of the knee could achieve satisfying clinical therapeutic effects as combined with appropriate postoperative rehabilitation training. |
| KEY WORDS Tibial plateau Fractures Fracture fixation,internal Operative approach |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 洪锋,王楠,陈冠军.后内侧入路倒L形切口结合重建钢板治疗胫骨平台后髁骨折[J].中国骨伤,2016,29(11):1027~1032 |
| 英文格式: | HONG Feng,WANG Nan,CHEN Guan-jun.Posterior medial approach inverted L-shaped incision combined with reconstruction plate for posterior condylar fracture of tibial plateau[J].zhongguo gu shang / China J Orthop Trauma ,2016,29(11):1027~1032 |
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