胫骨平台后柱骨折不同手术径路内固定的疗效分析

Analysis of curative effect of different surgical approaches for posterior column fracture in tibial plateau

目的探讨胫骨平台后柱骨折的手术方式,分析比较应用不同手术径路内固定的疗效。方法手术治疗胫骨平台后柱骨折29例,其中采用后内侧、前侧联合入路10例(posteromedial plus anterior approach,PMA组),前侧入路19例(anterior approach,AA组),对两组患者的骨折愈合时间、胫骨平台后倾角及内翻角、Rasmussen复位解剖学评分、HSS膝关节功能评分进行统计学分析,以期了解不同径路术式与骨折愈合、复位效果、复位稳定性及膝关节功能的相互关系。结果PMA组骨折愈合时间少于AA组。PMA组、AA组的术后即刻与术后12个月胫骨平台后倾角、内翻角比较,均无统计学差异(P>0.05)。术后即刻Rasmussen复位解剖学评分、术后12个月HSS膝关节功能评分两组无统计学差异(P>0.05)。结论胫骨平台后柱骨折前后联合入路手术可以缩短骨折愈合时间,而骨折复位效果、复位的稳定性及膝关节功能恢复两组术式并无差别,应依据胫骨平台后侧骨折块的大小、位置以及骨折断端的走向、移位选择手术径路。

Objective To investigate the operative procedures of posterior column fracture in tibial plateau,analyze and compare the curative effect of different surgical approaches.Methods Twenty nine cases of posterior column fracture in tibial plateau were operated.There were 10 cases of posteromedial plus anterior approach（PMA）,and 19 cases of anterior approach（AA）.The fracture healing time,tibial plateau posterior slope angle and varus angulation,Rasmussen reset anatomy score,HSS function scores of knee were statistically analyzed,in order to find out interrelationship between the different path operation type and fracture healing,reduction effect,reduction stability and knee joint function.Results Fracture healing time in group PMA was less than in group AA.A comparison concerning tibial plateau posterior slope and varus angle was made immediately after operation with 12 months after operation in group PMA and group AA,the difference was of no significance（P 0.05）.There was no significant difference in Rasmussen reset anatomical score immediately after operation and HSS knee function score 12 months after operation in two groups（P 0.05）.Conclusion Anterior and posterior approach operation of posterior column fracture in tibial plateau can shorten the time of fracture healing.There are no differences among the reduction effect,the reduction stability and function recovery in knee joint in the two groups.The surgical approach should be chosen based on the size and position and direction and displacement of posterior tibial plateau fracture block.