后侧入路内固定治疗46例累及胫骨平台后柱骨折患者的疗效观察

Therapeutic effect of posterior approach internal fixation for the treatment of tibial plateau posterior column fracture in 46 cases

目的探讨膝关节后侧入路内固定治疗累及胫骨平台后柱骨折的手术方法和近期疗效。方法回顾性分析2008年1月至2011年1月该院收治的后侧入路内固定治疗46例累及胫骨平台后柱骨折患者的临床资料。结果 46例患者均获得随访,随访时间9～24个月,平均13.7个月。无1例发生切口感染、血管神经损伤、内固定松动及断裂,骨折均愈合。Rasmussen放射学评分为10～18分,平均15.1分,其中优21例,良18例,可5例,差2例,优良率为84.8%。术后美国特种外科医院(HSS)膝关节功能评分,平均89.3分,其中优31例,良7例,可6例,差2例,优良率为82.6%。结论后侧入路内固定手术治疗累及胫骨平台后柱的骨折,具有直视下进行复位固定、符合生物力学、创伤小及临床疗效好等优点。

Objective To investigate the surgical technique and therapeutic effect of posterior approach internal fixation for the treatment of tibial plateau posterior column fracture. Methods 46 cases with tibial plateau posterior column fractures from January 2008 to January 2011 were reviewed retrospectively. Results The follow-up lasted 9--24 months （mean 13.7 months） in the 46 patients. There was no infection,no nerve injuries and loosening or breakage of the screw. All cases had attained bone union. Ras- mussen score was 10-18 （mean 15.1）. There were excellent in 21 cases,good in 18 cases,fair in 5 cased and bad in 2 cases. The excellent and good rate of clinical results was 84.8 %. The mean HSS （Hospital for Special Surgery） score was 89.3, and there were excellent in 31 cases,good in 7 cases,fair in 6 cases and bad in 2 cases. The excellent and good rate was 82.6%. Conclusion Pos- teromedial and posterolateral approaches can facilitate the reduction and fixation for tibial plateau posterior column fractures. It has many advantages such as good exposure,coincidence with biomechanics,less invasion and the excellent clinical results.