【摘要】 目的探讨采用改良前外侧入路治疗老年Schatzker V型及VI型骨折的优势。方法对我院2016～2018年收治的35例老年复杂性胫骨平台骨折患者(Schatzker V型及VI型)的临床资料进行分析。均采用改良前外侧入路进行手术治疗。术后即刻及1、2、3、6、12个月对患者进行X线片检查,测量胫骨平台内翻角(tibial plateau angle,TPA)及后倾角(posterior slope angle,PA),采用Rasmussen放射学评分评价手术复位及骨折愈合情况,采用Rasmussen膝关节功能评分及美国纽约特种外科医院(HSS)评分系统,对患者膝关节功能康复进行评价。结果本组共35例,其中男15例,女20例,年龄61～81岁,平均(69.46±6.15)岁。Schatzker分型V型20例,VI型15例。术后即刻X线片显示共30例获解剖复位,5例关节面遗留<2 mm台阶。Rasmussen放射学评分12～18分,平均(16.26±1.93)分。各时间点TPA值相比,差异无统计学意义(F=0.05,P=0.99)。各时间点内侧PA值相比,差异无统计学意义(F=0.08,P=0.99)。各时间点外侧PA值相比,差异无统计学意义(F=0.07,P=0.98)。术后HSS评分为79～95分,平均(86.51±4.29)分。Rasmussen膝关节功能评分为18～29分,平均(25.54±2.96)分。膝关节活动范围为90°～135°,平均(120.37±10.99)°。所有患者术后1年随访均显示骨折愈合。结论采用改良前外侧入路治疗老年Schatzker V型及VI型胫骨平台骨折具有术中软组织损伤小的特点,且Rasmussen评分及HSS评分显示术后膝关节功能恢复满意。更多还原

【Abstract】 Objective To explore advantages of modified anterolateral approach in the treatment of Schatzker V and VI fractures in the elderly. Methods Clinical data of 35 elderly patients with complex tibial plateau fracture( Schatzker V and VI) admitted to our hospital from 2016 to 2018 were reviewed. Modified anterolateral approach was used for surgical treatment. Patients were examined by X-ray immediately and 1, 2, 3, 6, 12 months after operation.The tibial plateau angle( TPA) and posterior slope angle( PA) were measured. The reduction and fracture healing were evaluated by Rasmussen radiological score. The rehabilitation of knee joint function was evaluated by Rasmussen knee function score and Hospital for Special Surgery Knee( HSS) score system. Results There were 15 males and20 females in this group, ranging in age from 61 to 81 years with an average of( 69.46 ± 6.15) years. Schatzker typing included 20 cases of V type and 15 cases of VI type. Immediately after operation, X-ray films showed that30 cases were anatomically reduced and 5 cases had articular surface with < 2 mm steps. Rasmussen radiological score ranged from 12 to 18 with an average of( 16.26 ± 1.93). There were no statistical differences in TPA values measured by X-ray examination at each time point( F = 0.05, P = 0.99); no statistical differences in medial PA values at each time point( F = 0.08, P = 0.99); no statistical differences in lateral PA values at each time point( F = 0.07, P = 0.98).Postoperative HSS scores ranged from 79 to 95 with an average of( 86.51 ± 4.29). Rasmussen knee function score ranged from 18 to 29 with an average of( 25.54 ± 2.96). The range of motion of the knee joint ranged from 90°-135°with an average of( 120.37 ± 10.99) °. All patients were followed up 1 year after operation and showed fracture healing. Conclusions Modified anterolateral approach has characteristics of less soft tissue injury during operation in the treatment of Schatzker V and VI tibial plateau fractures in elderly patients. Rasmussen score and HSS score show satisfactory recovery of knee joint function after operation.更多还原