改良侧后方入路胫骨平台后方骨折.docVIP

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，用3.5 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，平均14.5个月。术后1个月80°～130°，平均105°；术后3个月90°～135°，平均115.3°；术后12个月膝关节屈伸范围：115°～135°，平均125.1°。术后即刻，术后3个月及1年的TPA和PA度数无统计学差异(P0.05)。术后1年膝关节HSS评分86～97分，平均92.1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 gastrocnemius or a posterolateral approach made through the gap of popliteus and soleus. A 3.5 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 14.5 (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 115.3° (ranged from 90° -135° ) at the 3rd month. One year later, the flexion of the knees achieved 125.1° (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 (P0.05) .According to the HSS system ,the mean score was 92.1(ranged from 76-97) one yea