%0 Journal Article
%T 复杂型胫骨平台骨折手术策略及疗效分析
%A 李军
%A 张兴睿
%A 胡文勇
%J 华西医学
%P 890-892
%D 2011
%X 【】　目的　探讨复杂型胫骨平台骨折改良手术入路及双侧双钢板固定临床疗效。　方法　2006年3月―2008年12月，收治复杂型胫骨平台骨折21例，其中男14例，女7例；平均年龄37岁。按Schatzker骨折分类Ⅴ型10例，Ⅵ型11例。均选择前外侧联合后内侧或后侧入路，双侧双钢板固定，术中探查半月板及交叉韧带损伤，一期修复处理及行交叉韧带重建。　结果　术后伤口Ⅰ期愈合19例，Ⅱ期愈合1例，1例术后10d发生切口皮缘坏死，经换药后愈合。所有患者均获1~3年随访，平均19.5个月。骨性愈合时间5~10个月，平均7.4个月。出现创伤性关节炎2例，关节面塌陷2例，其中1例有轻度膝关节内翻。按美国特种外科医院评分标准优18例，良2例，可1例，优良率95.2%。　结论　复杂型胫骨平台骨折运用前外侧联合后内或后侧切口入路，双侧双钢板固定，利于保护软组织血供、固定可靠稳定性好，是切实可行的有效方法。【Abstract】　Objective　Tostudytheclinicalefficacyofmodifiedsurgicalapproachandbilateraldouble-platefixationinthecasesofcomplextibialplateaufracture.　Methods　FromMarch2006toDecember2008,21patientswithcomplextibialplateaufracture,including14malesandsevenfemales,weretreatedinourhospital.Theaverageageofthemwas37yearsold.BasedonSchatzkerfractureclassification,therewere10casesoftypeⅤand11casesoftypeⅥfracture.Allthecasesweretreatedbythecombinedanterolateralandposteromedialorposteriorapproachesandbilateraldouble-platefixation.Intheoperation,weexploredinjuriesonthemeniscusandcruciateligament,andcarriedouttheone-stagerehabilitationandcruciateligamentreconstruction.　Results　Therewere19casesofone-stagehealing,andonecaseofsecondaryhealing.Onepatientsufferedskinflapnecrosis10daysaftertheoperation,andwascuredafterchangingthemedicine.Allthepatientswerefollowedupforonetothreeyears,averagingat19.5months.Bonehealingoccurredwithin5to10monthsaveragingat7.4months.Twopatientssufferedtraumaticarthritis;articularsurfacecollapsewasfoundintwopatients;andonepatienthadmildvarusknee.AccordingtothescoringsystemfromHospitalforSpecialSurgery,therewere18casesofexcellentefficacy,twoofgoodefficacy,oneoffairefficacy,withanexcellencerateof85.2%.　Conclusion　Combinedanterolateralandposteromedialorposteriorapproachesandbilateraldouble-platefixationforcomplextibialplateaufracturesisbeneficialtoprotectthesofttissuebloodsupplyandgivereliablefixationstability.Thus,itisafeasibleandeffectivemethodandisworthfurtherresearchandpopularizinginclinicalpractices.
%K 胫骨平台骨折
%K 双钢板
%K 内固定术
%U http://www.hxyxqk.com.cn/oa/DArticle.aspx?type=view&id=201106026