| 胫骨内侧平台大块劈裂骨折手术方式和疗效分析 |
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Received:February 06, 2018
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| 作者 | Author | 单位 | Unit | E-Mail |
| 张勇 |
ZHANG Yong |
宁波市第六医院创伤骨科, 浙江 宁波 315040 |
Department of Orthopaedics Surgery, Ningbo No.6 Hospital, Ningbo 315040, Zhejiang, China |
zhangberry2011@163.com |
| 王庆 |
WANG Qing |
宁波市第六医院创伤骨科, 浙江 宁波 315040 |
Department of Orthopaedics Surgery, Ningbo No.6 Hospital, Ningbo 315040, Zhejiang, China |
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| 何贤峰 |
HE Xian-feng |
宁波市第六医院创伤骨科, 浙江 宁波 315040 |
Department of Orthopaedics Surgery, Ningbo No.6 Hospital, Ningbo 315040, Zhejiang, China |
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| 校佰平 |
XIAO Bai-ping |
宁波市第六医院创伤骨科, 浙江 宁波 315040 |
Department of Orthopaedics Surgery, Ningbo No.6 Hospital, Ningbo 315040, Zhejiang, China |
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| 庄云强 |
ZHUANG Yun-qiang |
宁波市第六医院创伤骨科, 浙江 宁波 315040 |
Department of Orthopaedics Surgery, Ningbo No.6 Hospital, Ningbo 315040, Zhejiang, China |
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| 胡勇 |
HU Yong |
宁波市第六医院创伤骨科, 浙江 宁波 315040 |
Department of Orthopaedics Surgery, Ningbo No.6 Hospital, Ningbo 315040, Zhejiang, China |
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| 马维虎 |
MA Wei-hu |
宁波市第六医院创伤骨科, 浙江 宁波 315040 |
Department of Orthopaedics Surgery, Ningbo No.6 Hospital, Ningbo 315040, Zhejiang, China |
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| 期刊信息：《中国骨伤》2018年31卷，第9期，第853-857页 |
| DOI：10.3969/j.issn.1003-0034.2018.09.014 |
| 基金项目:2018宁波市鄞州区农社类科技项目（编号：20180137） |
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目的：探讨经内侧入路保护内侧结构，两个不同方向内固定治疗以内侧大块劈裂为主的胫骨平台骨折的可行性和有效性。
方法：自2010年1月至2016年1月采用膝内侧切口保护内侧软组织结构，不同方向固定胫骨内侧骨折块治疗涉及大块劈裂的胫骨内侧平台骨折患者21例，男17例，女4例；年龄27~63（39.2±3.2）岁。术前影像学检查（X线或CT）确诊，取膝关节内侧切口入路，保护膝内侧结构同时行内侧和内后侧钢板支撑内固定术；合并外侧平台骨折予外侧或外后侧切口复位固定。术后即刻根据Rasmussen放射学评分标准评价骨折复位情况，术后1年随访时根据美国特种外科医院（Hospital for Special Surgery，HSS）膝关节评分系统评定疗效。术后通过X线及临床检查判断骨折愈合时间，记录并发症及相应转归。
结果：术后患者切口均Ⅰ期愈合，未见明显并发症。21例患者术后均获随访，时间10~24（17.2±1.7）个月。骨折均愈合，愈合时间为9~16（11.1±3.2）周。术后骨折复位Rasmussen放射学评分1~18（16.7±1.5）分；优16例，良3例，可2例。末次随访时HSS膝关节评分60~100（87.3±6.7）分；优18例，良2例，可1例。
结论：对于大块劈裂的胫骨内侧平台骨折，内侧切口、充分保护膝内侧结构、两个不同方向支撑钢板固定方法可行，近期疗效满意。 |
| [关键词]:胫骨骨折 膝关节 骨折固定术,内 |
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| Surgical methods and curative effect of tibial plateau fracture with medial large block split |
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Abstract:
Objective: To explore the clinical effects of protecting the internal structure of the knee and internal fixation through two different directions for the treatment of tibial plateau fractures with medial large block split.
Methods: From January 2010 to January 2016,data of 21 patients of tibial plateau with medial large block split fractures who were treated with protecting the internal structure of the knee and internal fixation through two different directions were retrospectively analyzed,including 17 males and 4 females,with an average age of (39.2±3.2) years old ranging from 27 to 63 years. Anteroposterior and lateral radiographs as well as computed tomography(CT) images were obtained in the course of preoperative. It was made in the operation to protect medial knee structure,combining with internal fixation via two different directions plates(medial and posteromedial). If the posterolateral condyle fracture was involved,a plate was applied through posterolateral approach. Rasmussen score was used for radiological assessment,and HSS knee score was used for efficacy assessment at 1 year after operation. The fracture healing time was judged by X-ray and clinical examinations,additionally,the complications and corresponding outcomes were also recorded.
Results: All patients were followed up for 10 to 24 months with an average of(17.2±1.7) months. All fractures were healed,the healing time was 9 to 16 weeks with an average of(11.1±3.2) weeks. The Rasmussen score after surgery was 1 to 18 points with an average of(16.7±1.5) points. Sixteen cases got excellent,3 good and 2 fair. At the final follow-up,HSS functional scores ranged from 60 to 100 points with an average of (87.3±6.7) points,the result was excellent in 18 cases,good in 2 cases and fair in 1 case.
Conclusion: For a split fracture of the medial tibial plateau,the medial incision,full protection of the medial knee structure,and two different directions of supporting plate fixation are feasible,and the short-term effect is satisfactory. |
| KEYWORDS:Tibial fractures Knee joint Fracture fixation,internal |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 张勇,王庆,何贤峰,校佰平,庄云强,胡勇,马维虎.胫骨内侧平台大块劈裂骨折手术方式和疗效分析[J].中国骨伤,2018,31(9):853~857 |
| 英文格式: | ZHANG Yong,WANG Qing,HE Xian-feng,XIAO Bai-ping,ZHUANG Yun-qiang,HU Yong,MA Wei-hu.Surgical methods and curative effect of tibial plateau fracture with medial large block split[J].zhongguo gu shang / China J Orthop Trauma ,2018,31(9):853~857 |
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