摘要
目的探讨漂浮体位下后内侧联合前外侧入路治疗累及后内侧髁胫骨平台双髁骨折的临床疗效。方法收集累及后内侧髁的胫骨平台双髁骨折患者54例膝关节,均为单膝损伤,其中C1型13例,C2型17例,C3型24例。手术均采用漂浮体位下通过后内侧联合前外侧入路,术中探查半月板、韧带损伤情况并予以相应的修复,骨折予以复位、植骨支撑、钢板固定,术后制定康复方案,定期随访。结果本组54例患者平均住院时间18.7±5.6 d,随访6~49个月,平均随访时间17.86±3.57月;愈合时间为7.45±1.34月。住院时间与性别和年龄均无关,但与AO分型有关;愈合时间和总有效率均与性别无关,但均与年龄和AO分型有关。术后无1例发生切口及深部感染、切口周围皮瓣坏死、关节不稳、骨筋膜室综合征和内、外翻畸形愈合等并发症。术后至取出内固定装置,无1例出现钢板螺钉松动和断裂、膝关节明显强直。根据Sanders膝关节功能评分标准,显效31例,有效17例,尚可5例,无效1例,总有效例数48例,总有效率为88.89%。结论采用漂浮体位下后内侧联合前外侧入路可有效取得骨折的复位、固定牢靠,远期疗效满意。
Objective To investigate the clinical efficacy of bicondylar fracture of tibialplateau involving posterior medial condyle by floating position with posteromedial combined anterolateral approach.Methods 54 knees with bicondylar fracture of tibial plateau involving posterior medial condyle were collected,and all the cases were unilateral knee fracture,including 13 cases were C1 type,17 cases were C2 type and 24 cases for C3 type.The patients with meniscus and ligament injury were repaired and reconstructed floating position with posteromedial combined anterolateral approach,and the fractures were reduced,bone grafted and fixed by plates,then performed postoperative rehabilitation plan and follow-up regularly.Results The average hospitalization time of 54 patients in this group was 18.7±5.6 days.All the patients were follow-up by 6~49 months,and the average follow-up time was 17.86±3.57 months.The healing time was 7.45±1.34 months.The hospitalization time was independent of sex and age,but related to AO classification;the healing time and total effective rate were independent of sex,but both related to age and AO classification.No wound or deep infection occurred after operation,no complications such as necrosis of flap around incision,joint instability,periosteal compartment syndrome and internal or external varus deformity were found.From the postoperative period to the removal of the internal fixation device,there was no case of loosening or breaking of plate screws and obvious knee joint stiffness.According to Sanders's score,there were 31 excellent cases,17 effective cases,5 fair cases and 1 invalid case.Totally 48 cases were effective,and the total effective rate was 88.89%.Conclusion For bicondylar fracture of tibial plateau involving posterior medial condyle,floating position with posteromedial combined anterolateral approach could effectively obtain the reduction and firm fixation,and the long-term effect is satisfactory.
作者
朱强
张阳春
薛春堂
杜增峰
余慧平
马志远
ZHU Qiang;ZHANG Yang-chun;XUE Chun-tang;DU Zeng-feng;YU Hui-ping;MA Zhi-yuan(The First Hospital of Yulin,Yulin 718000,China;People′s Hospital of Shenzhen Baoan District,The Second Affiliated Hospital of Shenzhen University,Shenzhen 518101,China)
出处
《延安大学学报（医学科学版）》
2020年第4期34-38,共5页
Journal of Yan'an University:Medical Science Edition
关键词
胫骨平台双髁骨折
漂浮体位
后内侧联合前外侧入路
疗效分析
Bicondylar fracture of tibialplateau
Floating position
Posteromedial combined anterolateral approach
Clinical analysis
