经腘窝腓肠肌内外侧头入路治疗累及后柱的老年胫骨平台骨折临床效果

Clinical Observation of Internal and External Head Approach through Popliteal Gastrocnemius in the Treatment of Tibial Plateau Fractures Involving Posterior Column

【目的】探讨经腘窝腓肠肌内外侧头入路治疗累及后柱的老年胫骨平台骨折患者的临床效果。【方法】纳入2012年1月至2020年1月98例累及后柱的老年胫骨平台骨折患者,依照随机数表法分为观察组和对照组,每组49例。观察组采用经腘窝腓肠肌内外侧头入路治疗,对照组采用标准前外侧入路。采用影像学检查测量胫骨平台内翻角和后倾角,术后12个月采用Rasmussen放射学评分评定疗效,采用美国纽约特种外科医院评分系统(HSS)评定患者膝关节功能和稳定性,比较两组患者治疗效果。【结果】两组平均手术时间、平均术中出血量比较,差异均无统计学意义(P>0.05)。观察组术后住院时间、骨折愈合时间均短于对照组(P<0.05);术后即刻、术后1个月、术后3个月、术后6个月、术后12个月各时间点两组患者胫骨平台内翻角和后倾角比较,差异均无统计学意义(P>0.05)。观察组Rasmussen评分(15.72±2.26)分,优良率为100%,对照组Rasmussen评分(14.05±1.98)分,优良率为91.84%(45/49),观察组Rasmussen评分和优良率均高于对照组(P<0.05)。术后12个月,观察组HSS评分和膝关节活动范围均高于对照组(P<0.05);观察组仅1例患者于术后1个月发生感染,经治疗后恢复正常,对照组1例关节僵硬,经针对性康复训练后缓解。【结论】经腘窝腓肠肌内外侧头入路治疗累及后柱的老年胫骨平台骨折患者,术后骨折愈合良好,膝关节功能恢复正常,是一种安全可靠的治疗方法。

【Objective】To investigate the clinical effect of popliteal gastrocnemius internal and external head approach in the treatment of elderly patients with tibial plateau fractures involving the posterior column.【Methods】A total of 98 elderly patients with tibial plateau fractures involving the posterior column from January 2012 to January 2020 was randomly divided into observation group and control group,with 49 cases in each group.The observation group was treated by internal and external head approach through popliteal gastrocnemius muscle,and the control group was treated by standard anterolateral approach.The tibial plateau varus angle and caster angle were measured by imaging examination.12 months after operation,the curative effect was evaluated by Rasmussen radiology score,and the knee function and stability were evaluated by New York Special Surgery Hospital scoring system(HSS).The therapeutic effects of the two groups were compared.【Results】There was no significant difference in average operation time and average intraoperative bleeding between the two groups(P>0.05).The postoperative hospital stay and fracture healing time in the observation group were shorter than those in the control group(P<0.05);There was no significant difference in tibial plateau varus angle and retroversion angle between the two groups immediately after operation,1 month,3 months,6 months and 12 months after operation(P>0.05).The Rasmussen score of the observation group was(15.72±2.26),and the excellent and good rate was 100%.The Rasmussen score of the control group was(14.05±1.98),and the excellent and good rate was 91.84%(45/49).The Rasmussen score and excellent and good rate of the observation group were higher than those of the control group(P<0.05).12 months after operation,the HSS score and knee range of motion in the observation group were higher than those in the control group(P<0.05);In the observation group,only one patient developed infection one month after operation and returned to normal after treatment.In the control group,one patient had joint stiffness and relieved after targeted rehabilitation training.【Conclusion】The internal and external head approach through popliteal gastrocnemius muscle is a safe and reliable method for the treatment of elderly patients with tibial plateau fractures involving the posterior column.The postoperative fracture healing is good and the knee function returns to normal.