胫骨平台后内侧骨折的两种手术入路比较
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摘要
目的探讨两种手术入路内固定术对胫骨平台后内侧骨折(PMF-TP)的疗效影响。方法选取2014年3月至2017年3月本院收治的PMF-TP患者80例,依据完成手术的不同路径,每组40例,常内组给予常规膝关节后内侧入路手术治疗,改内组给予改良髌旁内侧入路手术治疗,比较两组手术、并发症、骨折复位、膝关节功能情况。结果改内组术中出血量、手术、住院、负重锻炼、骨折愈合时间明显低于常内组,差异有统计学意义(P<0.05);改内组并发症率明显低于常内组,差异有统计学意义(P<0.05);改内组术后6个月骨折复位、膝关节功能优良率明显高于常内组,差异有统计学意义(P<0.05)。结论改良髌旁内侧入路较常规的后内侧入路相对简单且安全。
Objective To discuss the effect of two internal fixation on posteromedial fracture of tibial plateau(PMF-TP).Methods Eighty patients with PMF-TP were selected from March 2014 to March2017 in our Hospital.According to different surgical approaches,the patients were divided into two groups,posteromedial approach group(40 cases)and parapatellar anteromedial approach group(40 cases).The former was treated with routine posteriormedial approach of knee joint,the later was treated with improved parapatellar anteromedial approach.The operation,complications,fracture reduction and knee joint function of the two groups were compared.Results The intraoperative blood loss,operation,hospitalization,weight bearing exercise,fracture healing time and incidence of complications of parapatellar anteromedial approach were significantly lower than those of the posteriormedial approach,and the difference was statistically significant(P<0.05).The fracture reduction and knee joint function excellent rate 6 months after operation of posteriormedial approach group were significantly higher than those of the parapatellar anteromedial approach,and the difference was statistically significant(P<0.05).Conclusion The modified medial parapatellar approach is simpler and safer than the conventional posteromedial approach.
Objective To discuss the effect of two internal fixation on posteromedial fracture of tibial plateau(PMF-TP).Methods Eighty patients with PMF-TP were selected from March 2014 to March2017 in our Hospital.According to different surgical approaches,the patients were divided into two groups,posteromedial approach group(40 cases)and parapatellar anteromedial approach group(40 cases).The former was treated with routine posteriormedial approach of knee joint,the later was treated with improved parapatellar anteromedial approach.The operation,complications,fracture reduction and knee joint function of the two groups were compared.Results The intraoperative blood loss,operation,hospitalization,weight bearing exercise,fracture healing time and incidence of complications of parapatellar anteromedial approach were significantly lower than those of the posteriormedial approach,and the difference was statistically significant(P<0.05).The fracture reduction and knee joint function excellent rate 6 months after operation of posteriormedial approach group were significantly higher than those of the parapatellar anteromedial approach,and the difference was statistically significant(P<0.05).Conclusion The modified medial parapatellar approach is simpler and safer than the conventional posteromedial approach.
引文
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[11]王浩汀,周一新.髌旁内外侧入路在外翻膝人工全膝关节置换术中的应用研究[J].中国医师杂志,2015,17(2):298-300.
[12]胡飞,尚希福,姚刚,等.髌旁内侧显露切开复位内固定治疗粉碎性髌骨骨折[J].中国骨与关节损伤杂志,2014,29(1):69-70.
[13]朱敏,徐永清,丁晶,等.改良胫骨近端后内侧入路在平台后侧骨折中的应用[J].实用骨科杂志,2014,20(5):423-426.2019-03-23
[2]De Boeck H,Opdecam P.Posteromedial tibial plateau fractures.Operative treatment by posterior approach[J].Clin Orthop Relat Res,1995,320:125-128.
[3]Sohn HS,Yoon YC,Cho JW,et al.Incidence and fracture morphology of posterolateral fragments in lateral and bicondylar tibial plateau fractures[J].J Orthop Trauma,2015,29(2):91-97.
[4]Chen HW,Liu GD,Ou S,et al.Open reduction and internal fixation of posterolateral tibial plateau fractures through fibula osteotomy-free posterolateral approach[J].J Orthop Trauma,2014,28(9):513-517.
[5]Venkatesan SK,Kanniraj M,Suresh S,et al.Prospective randomized trial comparing open reduction and internal fixation with minimally invasive reduction and percutaneous fixation in managing displaced intra-articular calcaneal fractures[J].Int Orthop,2014,38(12):2505-2512.
[6]朱华荣,徐晓峰,陈奇,等.膝关节囊对膝关节周围骨折术后膝关节功能的影响[J].中国骨与关节损伤杂志,2015,30(8):822-824.
[7]Hake ME,Goulet JA.Open Reduction and Internal Fixation of the Posteromedial Tibial Plateau via the Lobenhoffer Approach[J].J Orthop Trauma,2016,30(Suppl 2):S35-S36.
[8]杨业静,李林.膝关节后内侧小切口入路结合锚钉系统治疗后交叉韧带胫骨止点撕脱骨折效果观察[J].山东医药,2016,56(22):87-89.
[9]张磊,孔德明,王浩军,等.后内侧入路在治疗复杂胫骨平台骨折中的应用和疗效分析[J].实用骨科杂志,2015,21(07):648-651.
[10]Guzelali O,Baris Y,Ahmet O.Open reduction and internal fixation of the isolated tibial lateral plateau posterior fracture using direct posterior split gastrocncmius approach[J].Case Reports in Surgery,2015,15(5):1-5.
[11]王浩汀,周一新.髌旁内外侧入路在外翻膝人工全膝关节置换术中的应用研究[J].中国医师杂志,2015,17(2):298-300.
[12]胡飞,尚希福,姚刚,等.髌旁内侧显露切开复位内固定治疗粉碎性髌骨骨折[J].中国骨与关节损伤杂志,2014,29(1):69-70.
[13]朱敏,徐永清,丁晶,等.改良胫骨近端后内侧入路在平台后侧骨折中的应用[J].实用骨科杂志,2014,20(5):423-426.2019-03-23