三柱复杂胫骨平台入路选择-舟山市骨伤医院关节科详解.docx

三柱分型理论在复杂胫骨平台骨折手术入路选择中的应用明文义吴旭东戴海东赵进征浙江省舟山市中医骨伤联合医院骨科 316000【摘要】目的探讨应用三柱理论指导治疗复杂胫骨平台的临床疗效和意义。方法2012年6月-2015年3月收治复杂胫骨平台骨折患者60例，根据基于CT重建为基础的三柱分型理论，均为三柱骨折。随机分成观察组及对照组各30例。观察组患者采取漂浮体位下前外侧入路联合膝关节后内侧“L”形入路切开复位钢板内固定，对照组患者仰卧位下取膝前正中切口切开复位钢板内固定，比较两组手术相关指标、并发症及治疗效果。结果60例患者均获得随访，骨折均获得愈合。观察组手术时间少于对照组，术后下床活动时间、术后负重时间早于对照组，术后创口并发症发生率低于对照组，差异有统计学意义（P ﹤ 0. 05）；术中出血量、术后引流量、骨折愈合时间方面两组差异无统计学意义（均P ﹥ 0. 05）；Rasmussen评分及膝关节功能均优于对照组，差异均有统计学意义（均P ﹤ 0. 05）。结论根据三柱理论治疗复杂胫骨平台骨折，采取漂浮体位联合切口，软组织损伤小，骨折手术显露充分，固定更符合生物力学，有利于早期功能锻炼，疗效确切，值得推广。【关键词】胫骨平台骨折三柱理论骨折固定术Clinical application of the three column fractal theory In the choice of surgical approach in complex tibial plateau fractures MING Wen y, DAI Hai dong, ZHAO Jin zheng，et al. Departerment of Orthopedics, The United Hospital of TCM and Traumatology ,Zhoushan 316000, China 【Abstract】 Objective To explore and analyze The clinical curative effect and significance of complex tibial plateau fracture under the guidance of three column fractal theory. Methods 60 patients with complex tibial plateau fracture were selected from June 2012 to March 2015 . On the basis of the CT reconstruction as the basic three column fractal method, all the patients were three column fractures . They were randomly?divided into observation group and control group 30 cases each.The observation group were open reduction by posteromedial converse “L” approach and anterolateral approach in the floating position with plate internal fixation. The control group were treated by ante-medial approach with plate internal fixation in the supine position. Two groups were contrasted indicators related to the operation, complication and therapeutic effect. Results All the cases were followed. All fractures were healed. The operation time were less than that of the control group, the time of bed movement and the weight bearing time after the operation were earlier than that of the control group, Wound complications after surgery were lower than the control group, the difference was sta