摘要
目的 探讨经后内侧入路治疗胫骨平台后内侧劈裂骨折的手术方法和临床疗效.方法 回顾性分析2006年1月-2011年11月经后内侧入路治疗的胫骨平台后内侧劈裂骨折患者36例,其中男23例,女13例;年龄21~70岁,平均40.1岁.致伤原因:交通伤19例,高处坠落伤10例,平地跌伤5例,运动伤2例.均为新鲜闭合性骨折,受伤至手术时间2~16d.骨折CT分型:后内侧劈裂骨折11例,后内侧劈裂及后外侧塌陷骨折25例.术前评估包括膝关节正、侧位X线片和CT扫描及三维重建,所有患者均采用后内侧入路治疗. 结果 36例均获随访12~32个月,平均17.5个月.无切口感染和皮肤坏死,无内固定松动及断裂,无骨不愈合,无膝关节内、外翻畸形和骨折再移位.1例术后出现小腿内下方感觉麻木,经甲钴胺营养神经对症治疗3个月后完全恢复.后内侧骨折均达解剖复位.术后根据Rasmussen膝关节功能评价:优21例,良13例,可2例,优良率为94%. 结论 后内侧入路具有显露直接、充分,软组织损伤少,不涉及重要血管神经等优点,是治疗胫骨平台后内侧劈裂骨折的理想方法.
Objective To investigate the surgical technique and clinical outcome of posteromedial approach in treatment of posteromedial tibial plateau split fractures.Methods A retrospective review was performed on 36 cases of posteromedial tibial plateau split fractures operated via posteromedial approaches from January 2006 to November 2011.There were 23 males and 13 females,at age range of 21-70 years (average 40.1 years).Mechanism of injury was traffic accidents in 19 cases,a high fall in 10,slipping on the ground in five and sports in two.The fractures were all fresh closed fractures.Period from injury to operation was 2-16 days.CT classification of the fracture was 11 cases of posteromedial split fracture and 25 cases of posteromedial split and posterolateral depression fracture.Preoperative evaluation included anteroposterior and lateral radiography,CT scan and three-dimensional reconstruction.Results All 36 cases were followed up for 12-32 months (average 17.5 months),which showed none of following complications:incision infection,cutaneous necrosis,implant loosening or breakage,bone disunion,knee inversion or eversion and fracture redisplacement.One case presented with anesthesia at posterior lower part of the calf,but restored completely after three months of symptomatic nerve nourishment using mecobalamin.Posteriomeidal fractures obtained anatomical reduction.Joint function as assessed by Rasmussen criteria was excellent in 21 cases,good in 13 and fair in 2,with excellence rate of 94%.Conclusion Posteromedial approach is an ideal procedure for treatment of posteromedial tibial plateau split fractures,for its advantages over direct and complete exposure,minor soft tissue injury and absence of injury to major vascular nerves.
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2013年第9期853-856,共4页
Chinese Journal of Trauma
基金
义乌市科技攻关计划资助项目(2009-G3-02)
关键词
胫骨骨折
骨折固定术
内
膝关节
后内侧入路
Tibial fractures
Fracture fixation, internal
Knee
Surgical approaches