摘要
目的探讨后侧腘窝S形切口双窗口入路治疗胫骨平台后柱骨折的临床疗效和安全性。方法2015年5月—2017年7月收治13例同时累及后内侧柱和后外侧柱的复杂胫骨平台骨折。其中男9例,女4例;年龄33~64岁,平均46.5岁。致伤原因:交通事故伤5例,高处坠落伤2例,骑电动车摔伤4例,滑雪摔伤2例。术前膝关节活动度(35.1±9.2)°。受伤至手术时间7~19 d,平均13.3 d。采用后侧腘窝S形切口,分别经腓肠肌内侧头内侧(内侧窗)及腓肠肌内外侧头之间(腘窝窗)进入,直视下复位骨折并接骨板内固定。术后随访观察骨折愈合、下肢力线、关节面复位情况及膝关节活动度;术后12个月采用美国特种外科医院(HSS)膝关节功能评定标准评价膝关节功能。结果术后1例患者出现切口脂肪液化开裂,给予扩创后愈合;其余患者切口均Ⅰ期愈合,术中未发生血管神经损伤。患者均获随访,随访时间12~18个月,平均16个月。X线片复查示,骨折均愈合,愈合时间14~22周,平均18周。术后12个月随访关节面平整,无塌陷;膝关节活动度(109.5±13.6)°,与术前比较差异有统计学意义(t=18.879,P=0.000)。随访期间均未发生感染、骨折再次移位及继发膝关节内、外翻畸形等并发症。术后12个月膝关节HSS评分为82~96分,平均89.6分;获优10例,良3例。结论采用后侧腘窝S形切口双窗口入路治疗同时累及后内侧柱及后外侧柱的胫骨平台后柱骨折安全有效,膝关节功能恢复满意,临床疗效好。
Objective To evaluate the effectiveness and safty of posterior popliteal fossa S-shaped incision with double-window approach for the treatment of posterior column of tibial plateau fractures.Methods A retrospective analysis was made on the clinical data of 13 patients with complex tibial plateau fractures involving both posteromedial and posterolateral columns between May 2015 and July 2017.There were 9 males and 4 females,aged 33-64 years(mean,46.5 years).The causes of injury included traffic accident in 5 cases,falling from height in 2 cases,falling from electric bicycle in 4 cases,and falling because of skiing in 2 cases.The preoperative range of motion of the affected knees was(35.1±9.2)°.The time from injury to surgery was 7-19 days(mean,13.3 days).All patients underwent a posterior popliteal fossa S-shaped incision through the window of medial heads of gastrocnemius muscle(medial window)and the window between medial and lateral head of gastrocnemius muscle(popliteal fossa window)approaches.After a good visual control of fracture reduction,both posteromedial and posterolateral columns of tibial plateau fractures were fixed with buttress plate respectively.Bone union,limb alignment,articular surface,and range of motion were estimated after operation.The American Hospital for Special Surgery(HSS)score was used to evaluate functional outcomes of knees.Results After operation,1 patient had fat liquefaction and dehiscence of incision,which healed after expanding the wound;the other patients’incisions healed by first intention,and no vascular or nerve injury occurred during operation.All the 13 patients were followed up 12-18 months(mean,16 months).The X-ray films showed that all patients obtained good fracture unions,the fracture healing time was 14-22 weeks(mean,18 weeks).At 12 months after operation,the articular surface was smooth without collapse,and the knee range of motion was(109.5±13.6)°,showing significant difference when compared with preoperative value(t=18.879,P=0.000).No complication of infection,re-displacement of fracture,or secondary varus/valgus deformity was observed during follow-up.The HSS score was 82-96(mean,89.6)at 12 months after operation,with the result of excellent in 10 cases and good in 3 cases.Conclusion The posterior column fracture of tibial plateau involving both posteromedial and posterolateral columns treated by double-window approach through posterior popliteal fossa S-shaped incision is safe and effective,with satisfactory results and good recovery of knee joint function.
作者
姚俊娜
王洪刚
权松涛
冯伟
蔡利涛
杨明路
YAO Junna;WANG Honggang;QUAN Songtao;FENG Wei;CAI Litao;YANG MingLu(DepartmentⅡof Knee Surgery,Luoyang Orthopedic-Traumatological Hospital of Henan Province(Henan Provincial Orthopedic Hospital),Luoyang Henan,471002,P.R.China;Department of Orthopedics and Microsurgery,the First Affiliated Hospital of Sun Yat-Sen University,Guangzhou Guangdong,510080,P.R.China)
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2020年第5期574-578,共5页
Chinese Journal of Reparative and Reconstructive Surgery
基金
广东省科技计划项目(2016A020215046)
广东省自然科学基金资助项目(2016A030313240)。
关键词
胫骨平台骨折
后柱骨折
后侧入路
Tibial plateau fracture
posterior column fracture
posterior approach
