四柱理念指导下治疗胫骨平台后外柱骨折的临床观察

目的 考察四柱理念指导下经后内、后外侧入路行胫骨平台后外柱骨折手术的疗效。 方法 2014年1月-2016年6月,共入组14例胫骨平台骨折伴关节面塌陷患者,其中男性11例,女性3例,平均年龄(42.3±8.1)岁。患者合并有韧带损伤,但无半月板损伤。Schatzker骨折分型为:V型8例,Ⅵ型6例。患者均经后内、后外侧carlson入路或者腓骨小头上方入路行复位、内固定手术治疗。评价手术的临床疗效,考察骨折愈合、HSS膝关节评分及并发症的发生情况。 结果 14例患者均顺利完成手术,术中无并发症。平均手术时间为(3.44±0.85)h。术中平均出血量为(352.05±103.68)ml。患者均获骨性愈合(X线片证实愈合),愈合时间为11~19周,平均愈合时间(14.7±1.6)周。临床效果:9例为优,4例为良,总的优良率为92.86%。截至2017年6月30日,随访时间为12~28个月,平均随访时间(18.1±3.9)个月,患者的膝关节功能HSS评分平均为(86.4±3.1)分。术后及随访期间无并发症发生。 结论 本研究秉承四柱理念对胫骨平台后外柱骨折患者的手术治疗,使患者获得了较好的康复和肢体功能恢复。 

Clinical observation of the treatment of posterolateral tibial plateau fractures guided by four-column classification system

Objective To observe the effect of posteromedial approach and posterolateral approach for posterolateral tibial plateau fractures guided by four-column classification system. Methods From January, 2014 to June, 2016, 14 cases of tibial plateau fracture merge with articular surface collapse were included in the group. There were 11 males and 3 females. The average age was (42.3±8.1) years. The patient had ligamentous injuries, but no meniscus injury. The types of Schatzker fracture were as the follows:8 cases of type Ⅴ, and 6 cases of type Ⅵ. The patients were treated with internal fixation and internal fixation through both posterior and posterior lateral approach. To evaluate the clinical effect of the operation, the fracture healing, HSS knee joint score, and the occurrence of complications were investigated. Results All the 14 patients successfully completed the operation without complications. The average operation time was (3.44±0.85) h. The average amount of bleeding was (352.05±103.68) ml during the operation. The patients received bone healing (X-ray confirmed healing), the healing time was 11-19 weeks, and the average healing time was (14.7±1.6) weeks. Clinical effect:9 cases were excellent, 4 cases were good, the total excellent rate was 92.86%. Until June 30 in 2017, the follow-up times was 12-28 months, the average follow-up time was (18.1±3.9) months. And the average HSS score of the knee joint function was (86.4 ± 3.1) scores. No postoperative complications and follow-up period. Conclusion This study has been operated on the posterior lateral column fracture of tibial plateau by the four-column classification system, which makes the patients get better rehabilitation and limb function recovery.