联合入路内固定治疗胫骨平台粉碎性骨折的疗效观察

The curative effect observation of tibial plateau communited fractures treated with internal fixation through combined approaches

目的探讨前外侧联合后内侧入路内固定治疗胫骨平台粉碎性骨折的临床效果。方法采用前外侧联合后内侧入路内固定治疗56例胫骨平台粉碎性骨折患者。观察手术时间、术中出血量、术后引流量、骨折愈合时间;比较手术前后胫骨平台内翻角、胫骨平台后倾角;采用Rasmussen影像学评分、膝关节功能HSS评分评价术后骨折复位及膝关节功能恢复情况。结果患者均获得随访,时间13～25个月。手术时间84～150 min,术中出血量264～403 ml,术后引流量为106～160 ml,骨折愈合时间5～7个月。胫骨平台内翻角术后即刻为79. 2°～86. 6°(85. 2°±18. 4°),术后1年为83. 6°～88. 1°(84. 6°±17. 9°);胫骨平台后倾角术后即刻为9. 2°～11. 3°(11. 2°±2. 3°),术后1年为9. 9°～11. 6°(10. 4°±2. 8°)。Rasmussen评分术后即刻为14～18分;术后1年为15～18分; HSS评分术后6个月评分为72～94分,术后1年为84～96分。结论前外侧联合后内侧入路内固定治疗胫骨平台粉碎性骨折时术野清晰、复位固定牢靠,利于恢复下肢长度、力线和关节面平整。

Objective To investigate the clinical effects of anterolateral and postmedial approachs internal fixation for tibial plateau comminuted fractures. Methods Fifty-six patients with tibial plateau comminuted fractures were treated with anterolateral and postmedial approachs. The operation time, intraoperative blood loss, postoperative drainage volume, fracture healing time were observed.The tibial plateau varus angle and posterior slope angle before and after operation were compared; Rasmussen imaging score and knee joint function HSS scores were used to evaluate fracture reduction and knee function recovery. Results All patients were followed up for 13~25 months. The operation time was 84~150 min; intraoperative blood loss was 264~403 ml; postoperative drainage was 106~160 ml; fracture healing time was 5~7 months. The tibial plateau varus angle immediately after operation was 79.2°~86.6° （85.2°± 18.4°）, and was 83.6°~88.1° （84.6°±17.9°） at the postoperative 1 year. The posterior slope angle immediately after surgery was 9.2° ~11.3° （11.2°±2.3°）, and 9.9°~11.6° （10.4°±2.8°） at 1 year postoperaiton. Rasmussen score immediately after surgery was 14~18 points; 15~18 points at 1 year after surgery; HSS score was 72~94 points at 6 months postoperation,and 84~96 points at 1 year postoperation. Conclusions Anterior anterolateral combined with posteromedial approachs internal fixation in the treatment of comminuted tibial plateau fractures are clear in the operative field, can get firm reduction and fixation, and which is conducive to restore the length of the lower extremity, the force line and the articular surface.