前后联合切口入路治疗累及后柱的复杂胫骨平台骨折疗效分析

目的探讨前后联合切口入路治疗累及后柱的复杂胫骨平台骨折的临床疗效。方法回顾性分析惠州市中心人民医院创伤骨科2012年1月~2014年1月收治的累及后柱的复杂胫骨平台骨折患者22例,其中男性14例,女性8例;年龄20~70岁,平均49.7岁。致伤原因:道路交通伤15例,坠落伤7例。平台前外侧骨折6例,前内侧骨折11例,前内、前外广泛骨折5例。受伤至手术时间3~14d,平均6.5d。22例均采取前内侧或前外侧联合后内侧倒"L"型切口入路+支撑钢板内固定术治疗,分析患者的临床资料、手术时间、术中出血量、住院时间、术中并发症(切口感染、内固定松动或断裂情况)、骨折愈合时间(以X线片下骨折线消失为准)以及术后12个月膝关节美国特种外科医院(HSS)评分。结果所有患者手术顺利,手术时间(173.4±40.3)min,术中出血量(187.5±53.1)mL,术后住院时间(16.3±4.6)d,骨折愈合时间(31.2±7.5)周。术中及术后无严重手术相关并发症。所有患者获得随访,平均随访时间(15.3±4.9)个月;术后12个月时膝关节HSS评分为(84.6±17.3),优良率为81.8%(18/22),两侧膝关节活动度差异无统计学意义(P0.05)。结论对于累及后柱的复杂胫骨平台骨折,前内侧或前外侧联合后内侧倒"L"型切口入路对组织损伤小,骨折端暴露充分,利于直视下复位内固定,对膝关节远期影响较小。

Curative effect of anterior combined with posterior approach in treatment of complex tibial plateau fractures involving the posterior column

Objective To explore the curative effect of anterior combined with posterior approach in treatment of complex tibial plateau fractures involving the posterior column.Methods Twenty-two patients with complex tibial plateau fractures involving the posterior column treated in trauma department of orthopedics in Huizhou Central People`s Hospital from Jan.2012 to Jan.2014 were selected.There were 14 males and 8 females with age ranging from 20 to 70 years(average,49.7 years).Causes of injury included traffic accident in 15 cases and falling in 7 cases.There was anterolateral tibial plateau fracture in 6 cases,medial tibial plateau fracture in 11 cases,and extensive fracture of tibial plateau in 5 cases.The time from injury to operation was 3 to 14 days,averaging (6.5±2.2) days.They were all given steel plate internal fixation with inverted "L" incision approach from medial or anteromedial posterior commissure.The clinical data was analyzed retrospectively,including operative time,intraoperative blood loss,length of hospital stay,intraoperative complications,fracture healing time and American special surgical hospital (HSS) score in 12 months after surgery.Results All patients were operated successfully.The mean operation time was (173.4±40.3)min;the mean blood loss was (187.5±53.1)mL;the postoperative hospital stay was (16.3±4.6)d;and the mean fracture healing time was (31.2±7.5)weeks.There was no severe complication after surgery.The mean HSS score was 84.6±17.3 and the excellent and good rate was 81.8%(18/22) at 12 months after operation.There was no significant difference in range of motion between bilateral knee joints(P>0.05).Conclusion As for complex tibial plateau fractures involving the posterior column,steel plate internal fixation with inverted "L" incision approach from medial or anteromedial posterior commissure has advantages of less tissue injury and full exposure,which is helpful for the direct reduction and fixation of the knee joint with minimal influence.