胫骨平台内后侧骨折的临床治疗体会(1)
[摘要] 目的 分析不同方案治疗胫骨平台内后侧骨折的临床疗效，探讨其临床应用价值。 方法 选取我院收治的96例胫骨平台内后侧骨折患者，随机分为观察组及对照组各48例，分别实施前后联合入路、传统前方入路内固定治疗，并进行为期1年的随访，比较两组患者术后即刻Rasmussen评分以及手术前后美国特种外科医院(HSS)膝关节评分变化。 结果 观察组术后即刻Rasmussen评分、优良率、术后1年膝关节屈曲度、膝关节伸直度、HSS评分均显著高于对照组，差异有统计学意义(P<0.05)，两组患者骨折愈合时间比较，差异无统计学意义(P>0.05)。观察组患者随访期间未见并发症发生，对照组患者并发症发生率为8.3%。观察组总有效率为97.92%，显著高于对照组的87.50%，差异有统计学意义(P<0.05)。 结论 采用前后联合入路治疗胫骨平台内后侧骨折具有确切的临床疗效及良好的安全性，对患者膝关节功能改善有着积极意义，值得推广。
[关键词] 胫骨平台内后侧骨折；联合入路；内固定；膝关节功能；并发症
[中图分类号] R687.3 [文献标识码] B [文章编号] 1673-9701(2016)10-0066-04
[Abstract] Objective To analyze the clinical effect of different treatment of the tibial plateau fractures and to explore its clinical application value. Methods A total of 96 cases patients with fracture of the tibial plateau were objects for study， which had treated in our hospital， all the patients were divided into control group and observation group， each group of 48 cases， treated with combined approach internal fixation and the traditional anterior approach internal fixation respectively. All the patients for a period of 1 year of follow-up， the rasmussen score and HSS score were compared. Results The rasmussen score， excellent rate in one year after operation， the knee flexion and extension， the HSS score of the observation group were significantly higher than the control group， the difference was statistically significant(P<0.05). There was no significant difference in fracture healing time between the two groups(P>0.05). The patients in the observation group were no complication occurred during the follow-up， while the incidence of complication of control group was 8.3%. The total efficiency of the observation group was 97.92%， significantly higher than the control group(87.50%)， and the difference was statistically significant (P<0.05). Conclusion The combined approach internal fixation has exact clinical efficacy and good safety for tibial plateau fracture， have a positive impact on the improvement of knee joint function， worthy of promotion.
[Key words] Tibial plateau fracture in posterior； Combined approach internal fixation； Internal fixation； Knee joint function； Complication
胫骨平台内后侧骨折是临床较为少见的关节内骨折类型，多由屈曲位膝关节同时遭受轴向及内翻暴力所致，并可累及胫骨内、外侧髁后1/3等部位[1]。由于该类骨折位置较为靠后，而膝关节后侧解剖结构十分复杂，故常规手术入路往往存在暴露不充分、复位固定困难、易导致邻近血管损伤的弊端，治疗效果不甚理想，患者往往预后较差甚至出现严重功能残疾[2]。因此，关于胫骨平台内后侧骨折的有效治疗一直是困扰临床的难题之一。近年来，有学者提出以前侧+内后侧倒L形联合入路或后侧S型减张入路治疗胫骨平台内后侧骨折的方案，但其临床效果尚未得到全面证实[3，4]。我院于2012年1月～2015年1月对48例胫骨平台内后侧骨折患者采取上述方案实施治疗，取得了满意的效果，现报道如下。
1 资料与方法, 百拇医药(林铭)
[关键词] 胫骨平台内后侧骨折；联合入路；内固定；膝关节功能；并发症
[中图分类号] R687.3 [文献标识码] B [文章编号] 1673-9701(2016)10-0066-04
[Abstract] Objective To analyze the clinical effect of different treatment of the tibial plateau fractures and to explore its clinical application value. Methods A total of 96 cases patients with fracture of the tibial plateau were objects for study， which had treated in our hospital， all the patients were divided into control group and observation group， each group of 48 cases， treated with combined approach internal fixation and the traditional anterior approach internal fixation respectively. All the patients for a period of 1 year of follow-up， the rasmussen score and HSS score were compared. Results The rasmussen score， excellent rate in one year after operation， the knee flexion and extension， the HSS score of the observation group were significantly higher than the control group， the difference was statistically significant(P<0.05). There was no significant difference in fracture healing time between the two groups(P>0.05). The patients in the observation group were no complication occurred during the follow-up， while the incidence of complication of control group was 8.3%. The total efficiency of the observation group was 97.92%， significantly higher than the control group(87.50%)， and the difference was statistically significant (P<0.05). Conclusion The combined approach internal fixation has exact clinical efficacy and good safety for tibial plateau fracture， have a positive impact on the improvement of knee joint function， worthy of promotion.
[Key words] Tibial plateau fracture in posterior； Combined approach internal fixation； Internal fixation； Knee joint function； Complication
胫骨平台内后侧骨折是临床较为少见的关节内骨折类型，多由屈曲位膝关节同时遭受轴向及内翻暴力所致，并可累及胫骨内、外侧髁后1/3等部位[1]。由于该类骨折位置较为靠后，而膝关节后侧解剖结构十分复杂，故常规手术入路往往存在暴露不充分、复位固定困难、易导致邻近血管损伤的弊端，治疗效果不甚理想，患者往往预后较差甚至出现严重功能残疾[2]。因此，关于胫骨平台内后侧骨折的有效治疗一直是困扰临床的难题之一。近年来，有学者提出以前侧+内后侧倒L形联合入路或后侧S型减张入路治疗胫骨平台内后侧骨折的方案，但其临床效果尚未得到全面证实[3，4]。我院于2012年1月～2015年1月对48例胫骨平台内后侧骨折患者采取上述方案实施治疗，取得了满意的效果，现报道如下。
1 资料与方法, 百拇医药(林铭)