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扩大外侧S型入路治疗累及后柱的胫骨平台外侧骨折效果分析
作者:张理  潘竹  秦然  宋华荣 
单位:南京市第一医院 运动关节科, 江苏 南京 210000
关键词:胫骨平台骨折 扩大外侧S型入路 外侧柱 后柱 
分类号:R683
出版年·卷·期(页码):2022·50·第一期(60-64)
摘要:

目的:探究扩大外侧“S”型入路与前外侧入路治疗累及后柱的胫骨平台外侧骨折的治疗效果。方法:回顾性分析2016年1月到2018年12月南京市第一医院运动关节科3年内收治累及后柱的胫骨平台外侧骨折的患者28例,分别采用扩大外侧“S”型入路(2018年A组)和前外侧入路(2016—2017年B组对照组)进行切开复位内固定术,比较手术治疗的效果及膝关节功能康复情况。 结果:28例患者均获得完整病例资料,随访时间平均12.8个月,两组患者三个月复查CT显示骨折均愈合,长期随访未出现钢板螺钉断裂。但是A组患者关节面较平整,B组患者后方关节面出现5例塌陷超过4 mm。膝关节HSS评分(86.0±7.9) vs. (77.0±9.2),WOMAC评分(34.0±4.4) vs. (58.0±6.3),SF36评分(91.0±5.8) vs.(82.0±3.1),均显示A组患者膝关节功能恢复级生活质量优于B组患者。术后A组有1例出现皮缘部分坏死,无腓总神经损伤出现,余患者未出现手术并发症。结论:扩大外侧“S”型入路对胫骨外侧平台后柱暴露充分,单一入路可以解决外侧及后方的问题,且拥有较好的手术效果及安全性。

Objective:To explore the therapeutic effect of expanded lateral S approach and lateral anterior approach treating lateraltatinre anterior tibial platform fractures involving the posterior column. Methods:28 patients from January 2016 to December 2018, with expanded lateral S approach(group A in 2018) and anterior and lateral approach(served as control group i.g. group B from 2016 to 2017) for open reduction and internal fixation, comparing the effect of surgical treatment and knee functional rehabilitation. Results:Complete case data were obtained from 28 patients, with an average follow-up time 12.8 months. CTat three months showed both fracture healed and no plate screw broken in the long-term follow-up. While the joint surface of patients in Group A was flat,that of five patients in group B collapsed more than 4 mm. Knee HSS score(86±7.9) vs.(77±9.2), WOMAC score(34±4.4) vs. (58±6.3), and SF36 score(91±5.8) vs. (82±3.1) all showed better knee recovery and better quality of life in group A than those in group B.One postoperative case in group A had partial necrosis of the skin margin, no fibular nerve injury, and the remaining patients had no surgical complications. Conclusion:The expanded lateral S-type approach fully exposes the posterior column of the lateral tibial platform. A single approach can solve the lateral and posterior problems, and has good surgical effect and safety.

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