内外侧倒“L”形扩展入路结合深筋膜下分窗技术治疗胫骨平台骨折的疗效研究

Efficacy study of tibial plateau fractures with inside and outside the inverted "L"-shaped extension approach combined with deep fascia under sub-window technique

目的探讨在内外侧入路治疗胫骨平台骨折中通过深筋膜下分窗技术所达到的手术显露优化效果。方法从2013年10月~2016年3月,治疗胫骨平台骨折38例。根据Schatzker分型:Ⅱ、Ⅲ型12例,Ⅳ型5例,Ⅴ型15例,Ⅵ型6例。按照平台骨折的不同类型,选用单一内侧切口进行深筋膜下分窗,同时显露平台内前侧及内后侧,单一外侧切口进行深筋膜下分窗,同时显露平台外侧及外后侧,并结合钢板螺钉固定治疗。结果 38例患者均获得随访,随访时间为3~20个月,平均13个月。随访3个月时骨折线模糊,未见高度丢失。根据Rasmussen评分系统评定膝关节功能:优25例,良9例,可4例,优良率为89.4%。结论根据平台骨折类型而选用内外单侧、双侧入路或其扩展入路,应用深筋膜下分窗技术有手术显露清晰、易与复位固定、创伤小、手术安全性高、疗效满意等优点。

Objective To explore the effect ofintraoperative and lateral approach in the treatment oftibial plateau fractures by deep fascia sub-window technique. Methods From Oct 2013 to Mar 2016, 38 cases oftibial plateau fractures were treated. According to Schatzker classification： II and III type 12 cases, IV type 5 cases, V type 15 cases, VI type 6 cases. According to the different types of platform fractures, the use of a single medial incision for deep fascia sub-window at the same time revealed the front and rear side of the platform, a single lateral incision under the deep fascia sub-window at the same time to reveal the platform lateral and outside the back, and combined treatment of plate and screw fixation. Results All the 38 patients were followed up examination for 3 to 20 months, with an average of 13 months. The fracture line was blurred at 3 months follow-up and no height was lost. According to the Rasmussen scoring system, the knee function was evaluated： excellent in 25 cases, well in 9 cases and fine in 4 cases. The excellent rate was 89.4% Conclusion According to the type of platform fracture, the use of internal and external unilateral, bilateral approach or its expansion approach, the application of deep fascia under the sub-window technology has many advantages： such as clear surgery reveal, easv to reset fixed, small trauma, high safety, efficacy satisfaction, etc.