应用三柱理论手术治疗复杂胫骨平台骨折的临床研究

Clinical study on the application of three column theory in the treatment of complicated tibial plateau fractures

目的:探讨应用三柱理论指导手术治疗复杂胫骨平台骨折的临床疗效。方法:选取71例胫骨平台粉碎性骨折患者,均为闭合骨折,且为三柱骨折。其中观察组(36例)采用符合三柱理论原则的后内侧联合前外侧入路手术治疗;对照组(35例)采用常规膝前正中切口入路手术治疗。比较两组患者术后的各项疗效指标及术后12个月Rasmussen评分。结果:观察组术后平均负重时间(42.6±8.5)d,早于对照组的(49.9±10.2)d,差异具有统计学意义(P<0.05);观察组术后12个月的Rasmussen评分为16.5±2.5,优于对照组的12.5±3.1,差异具有统计学意义(P<0.05)。而两组术后即刻及12个月的内翻角及后倾角组间、组内比较差异均无统计学意义(P>0.05)。结论:三柱理论分型可以有效指导手术方案的制订,可获得更优良的复位及更坚强的固定,膝关节功能恢复好。

Objective： To investigate the clinical efficacy of three-column theory in guiding the treatment of complex tibial plateau fractures. Methods： 71 patients with tibial plateau comminuted fracture were selected, whose fracture were closed and three column fracture. Patients in the observation group （36 eases ） were treated with posterior medial anterolateral approach in line with the principle of three-column theory. Patients in the control group （35 cases） were treated with conventional knee median incision approach. All the curative effect indexes and Rasmussen score at 12 months after operation were compared between the two groups. Results： The mean postoperative weight- bearing time in the observation group was （42.6 ±8.5 ） d, which was earlier than that in the control group E （49.9 ±10.2） d], the difference was statistically significant（P 〈0.05）. The Rasmussen score in the observation group was 16.5 ±2.5 after 12 months, which was better than that in the control group （ 12.5±3.1 ） , the difference was statistically significant （P 〈 0.05 ）. However, there was no significant difference in tibial plateau tibial shaft angle （TPA） and posterior slope angle （PA）between the two groups after immediate postoperation and at 12 months after operation （P 〉 O. 05 ）. Conclusion： The three-column theoretical classification can effectively guide to formulate surgical programs, which can gain more excellent reduction, more reliable fixation and satisfactory recovery of the knee functions.