累及后柱的胫骨平台骨折的手术治疗

Surgical Treatment for Complex Tibial Plateau Fractures Involving the Posterior Column

目的:探讨累及后柱的胫骨平台骨折的手术治疗方法。方法:选取2011年2月-2012年12月本院收治的20例累及后柱的胫骨平台骨折患者为研究对象,其中后内伴后外侧骨折8例,后内侧劈裂骨折5例,后外侧劈裂骨折6例,合并胫骨近端骨折1例。根据后柱累及部位不同采取后内侧入路、后外侧入路骨折复位固定术,观察临床治疗效果及并发症情况。结果:本组患者术中出血量(178.32±2.01)mL,住院时间(16.12±1.23)d,骨折愈合时间(17.52±0.58)周,完全负重时间(17.60±1.22)周,膝关节活动度(115.36±2.6)°。膝关节功能恢复优者13例(65%),良者4例(20%),优良率85%。结论:膝关节后侧(后内侧或后外侧)入路复位及支撑钢板固定术具有复位合理、固定稳定性高、并发症少、膝关节功能恢复等优点,可作为累及后柱的胫骨平台骨折治疗的首选手段。

Objective： To discuss surgical treatment for the posterior column of the tibial plateau fracture. Method： 20 patients with column fracture of tibial plateau were selected in our hospital from February 2011 to December 2012, with the outside of the fracture in 8 cases, 5 cases of medial fracture splitting, splitting posterolateral fracture in 6 cases, combined proximal tibial fractures in 1 case, according to the inside to take the different parts of the posterior column involvement approach, posterolateral approach fracture fixation. The clinical effects and complications were observed.Result： The patients＇ blood loss was （ 178.32± 2.01 ）mL, length of stay was （ 16.12 ± 1.23 ）days, healing time was （ 17.52 ± 0.58 ） weeks, the time to full weight bearing was （ 17.60 ± 1.22 ） weeks, the knee activity was （ 115.36 ± 2.6 ） degrees. Recovery of knee function was excellent in 13 eases （ 65% ）, good in 4 cases （ 20% ）, excellent rate was 85%. Conclusion： The rear side of the knee （ medial or lateral after ） approach reset and buttress plate fixation with reset reasonable, fixed stability, fewer complications, recovery of knee function, etc., can be used as involving the posterior column of tibial plateau fractures treated preferred means.