摘要
目的探讨胫骨平台骨折三柱分型指导手术治疗复杂胫骨平台骨折的可行性。方法选择2013年4月至2014年3月解放军第二五一医院收治并确诊为胫骨平台骨折的患者80例(100侧)为研究对象,其中单纯压缩骨折10侧,单柱骨折48侧,双柱骨折31侧,三柱骨折11侧。根据三柱分型理论选取手术的入路和对应的内固定的方式,后侧柱使用倒L形入路,内侧柱使用改良正中入路,外侧住使用前外侧入路,双柱和三柱骨折使用联合入路手术。术后随访并使用纽约特种外科医院(HSS)评分评价临床治疗效果。结果术后12个月与术后即刻的外侧平台后倾角、内侧平台后倾角和平台内翻角比较差异均无统计学意义(P>0.05)。单纯压缩骨折组、单柱骨折组、双柱骨折组和三柱骨折组的平均等待时间为(3.2±0.5)d、(4.8±0.9)d、(6.1±0.9)d、(8.6±0.8)d,平均手术时间为(58.8±0.9)min、(73.2±2.1)min,(88±3.3)min、(97.8±5.1)min,手术中的平均失血量为(64±13)m L、(197±38)m L、(398±47)m L、(466±51)m L,单柱骨折组、双柱骨折组和三柱骨折组平均等待时间、平均手术时间、手术中的平均失血量显著高于单纯压缩骨折组,双柱骨折组和三柱骨折组显著高于双柱骨折组,三柱骨折组显著高于双柱骨折组,差异有统计学意义(P<0.05);单纯压缩骨折组、单柱骨折组、双柱骨折组和三柱骨折组骨折愈合的时间、术后12个月SF-36评分、术后12个月HSS评分比较差异无统计学意义(P>0.05)。结论三柱分型理论对复杂胫骨平台骨折的手术具有较好的指导作用,值得深入研究并推广使用。
Objective To Analyze the feasibility of treating complex tibial plateau fracture under the guidance of three-column classification theory. Methods Seventy-six（ 90 sides） patients with tibial plateau fracture admitted to PLA 251 st Hospital from Apr. 2013 to Mar. 2014. The ninety cases of tibial plateau fracture included 10 pure compression fractures,48 one-column fractures,31 two-column fracture and 11 threecolumn fractures. Anterior-lateral,modified midline and reversed L-shaped approaches were used to treat lateral column,medial column and posterior column fractures respectively. Combined approaches were applied for double column and three column fractures. Postoperative follow-up was done and clinical outcomes were evaluated according to HSS scores. Results The differences between 12 months after surgery and the immediate postoperative in the lateral platform rear angle,medial platform rear angle and tibial plateau angle were not statistically significant（ P〉 0. 05）. The average waiting time of surgery for pure compression fractures,one-column fracture,two-column fracture,three-column fractures were（ 3. 2 ± 0. 5） d,（ 4. 8 ± 0. 9） d,（ 6. 1 ± 0. 9） d,（ 8. 6 ± 0. 8） d,the average operative time of surgery were（ 58. 8 ± 0. 9） min,（ 73. 2 ±2. 1） min,（ 88 ± 3. 3） min,（ 97. 8 ± 5. 1） min,the average blood loss in surgery were（ 64 ± 13） m L,（ 197 ± 38） m L,（ 398 ± 47） m L,（ 466 ± 51） m L. The average waiting time,the average operative time of surgery,the average blood loss in surgery of one-column fracture,two-column fracture,three-column fractures were significantly higher than pure compression fractures,two-column fracture,three-column fractures were significantly higher than one-column fracture. three-column fractures were significantly higher than two-column fracture,and the differences were statistically significant（ P〈 0. 05）. There were no statistically significant differences in SF-36 scores and HSS score 12 months after surgery between pure compression fractures,one-column fractures,two-column fractures and three-column fractures（ P〉0. 05）. Conclusion Three-column classification theory of complex tibial plateau fracture has a good role in guiding surgery,thus is worthy of further study and should be promoted in clinical.
出处
《医学综述》
2016年第8期1646-1648,共3页
Medical Recapitulate
关键词
胫骨平台骨折
三柱分型
骨折固定术
Tibial plateau fractures
Three-column classification
Fracture fixation
