改良侧后方入路胫骨平台后方骨折.doc

改良侧后方入路胫骨平台后方骨折
改良侧后方入路治疗胫骨平台后方剪力骨折
来源:中国论文下载中心[ 10-05-04 15:12:00 ] 编辑:studa20
作者:陶杰,杭栋华,王秋根,高伟,朱力波,吴小峰,高堪达
【摘要】[目的]探讨改良侧后方入路治疗胫骨平台后方剪力骨折的手术效果。[方法]2003年8月~2006年7月,采用改良的侧后方“L”型入路治疗胫骨平台后方剪力骨折13例。后内侧入路经由半腱肌、半膜肌和腓肠肌内侧头间隙,后外侧入路自腘肌和比目鱼肌间隙分别显露后内与后外侧髁。骨折块直视下复位, mm“T型”锁定钢板或有限接触加压钢板于胫骨后内或后外侧固定骨块。半月板与韧带损伤均Ⅰ期修复。[结果]13例患者全部获得12个月以上的随访,随访时间13~16个月,。术后1个月80°~130°,平均105°;术后3个月90°~135°,°;术后12个月膝关节屈伸范围:115°~135°,°。术后即刻,术后3个月及1年的TPA和PA度数无统计学差异(P>)。术后1年膝关节HSS评分86~97分,。无1例发生手术区皮肤坏死、感染或内固定松动。[结论]本组所采用的改良后外侧或后内侧入路可充分暴露胫骨后平台,减少前方大范围剥离所带来的软组织并发症,直视下复位和固定骨折块可以充分防止力线的改变和骨折的再移位,有利于患者良好的膝关节功能恢复。
【关键词】胫骨平台后方骨折; 侧方入路; 膝关节功能; 钢板固定
Abstract:[Objective]A prospective study was designed to describe the patterns of posterior shearing tibial plateau fracture, and to evaluate the early results of surgical treatment by
posteromedial or posterolateral approach. [Method]From August 2003 to July 2006,13 patients were identified as having posterior shearing tibial plateau fractures and treated with a L shaped incision by a posteromedial or posterolateral approach made through the interval of
semitendinosus, semimembranosus and the medial head of emius or a posterolateral
approach made through the gap of popliteus and soleus. A mm LC DCP plate was used as a buttress to support the postero medial or posterolateral fragment which was visibly reduced. [Result]The average duration of follow up was (range, 13-16) months. All fractures healed after index surgery. The flexion of the knees achieved 105° (ranged from 80° -130° ) at the first month postoperatively. It was improved to ° (ranged from 90° -135° ) at the 3rd month. One year later, the flexion of the knees achieved ° (ranged from 115° -135° ).There was no significant difference between tibial plateau angle (TPA) and posterior slope angle(PA)
immediately ,3 months and one year after operation (P>) .According to the HSS system ,the mean score was (ranged from 76-97) one