陶杰;杭栋华;王秋根;高伟;朱力波;吴小峰;高堪达;

• 1:上海交通大学附属第一人民医院骨科

摘要(Abstract)：

[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Ⅰ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(P>0.05)。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(KeyWords)： 胫骨平台后方骨折;侧方入路;膝关节功能;钢板固定

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 陶杰;杭栋华;王秋根;高伟;朱力波;吴小峰;高堪达;

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参考文献(References)：

• [1]Peter A,Cole,Mohit B.What's new in orthopaedic trauma[J].JBone Joint Surg(Am),2006,88:2545-2561.
• [2]Timothy Bhattacharyya L,Pearce McCarty III,Mitchell B,et al.Theposterior shearing tibial plateau fracture.treatment and results via aposterior approach[J].J Orthop Trauma,2005,19:305-310.
• [3]AndrewJR,Tegger JL,Godbout BP.Bicondylar tibial plateau fracturecomplicated by compartment syndrome[J].Orthop Rev,1992,21:317-319.
• [4]Watson JT,Coufal C.Treatment of complex lateral plateau fracturesusing Ilizarov techniques[J].Clin Orthop,1998,353:97-106.
• [5]Gosling T,Schandelmaier P,Marti A.Less invasive stabilization ofcomplex tibial plateau fractures.Abiomechanical evaluation of a uni-lateral locked screw plate and double plating[J].J Orthop Trauma,2004,18:546-551.
• [6]Lobenhoffer P,Gerich T,Bertram T.Treatment of posterior tibialplateau fractures via posteromedial and posterolateral exposures[J].Unfallchirurg,1997,100:957-967.
• [7]Galla M,Lobenhoffer P.The direct,dorsal approach to the treatmentof unstable tibial posteromedial fracture-dislocations(German)[J].Unfallchirurg,2003,106:241-247.
• [8]DuWayne A,Carlson.Posterior bicondylar tibial plateau fractures[J].J Orthop Trauma,2005,19:73-78.
• [9]Johannes KM,Fakler,Mark R,et al.Optimizing the management ofmoore type I postero-medial split fracture dislocations of the tibialhead:description of the lobenhoffer approach[J].J Orthop Trauma,2007,21:330-336.
• [10]Raja Muhammad SK,Shuja HK,Agha Jamil A,et al.A new classiji-cation scheme[J].Clinical Orthopaedics and Related Research,2000,375:231-242.
• [11]Rademakers MV,Kerkhoffs GMMJ,Sierevelt I N,et al.Operativetreatment of 109 tibial plateau fractures:five-to 27-year follow-up results[J].J Orthop Trauma,2007,21:5-10.
• [12]杨胜松,王满宜,荣国威.SchatzkerⅣ型胫骨平台骨折的分型及治疗[J].中华外科杂志,2004,19:1161-1164.
• [13]吴宏斌,杜靖远,杨述华,等.MRI在胫骨平台骨折诊治中的意义[J].中国矫形外科杂志,2004,8:576-578.
• [14]Colletti P,Greenberb H,Terk MR.MR findings in patients with a-cute tibial plateau fracture[J].Commput Med Imaging,1996,20:389-394.
• [15]Chan KK,Resnick D,Goodwin D,et al.Posteromedial tibial plat-eau injury including avulsion fracture of the semimembranous tendoninsertion site:ancillary sign of anterior cruciate ligament tear at MRimaging[J].Radiology,1999,211:754-758.