【摘要】 [目的]探究后侧入路T形支撑钢板内固定治疗胫骨平台后柱骨折的临床疗效。[方法]2014年1月～2017年1月本院收治的65例胫骨平台后柱骨折患者为研究对象,均行后侧入路T形支撑钢板内固定术治疗。回顾分析手术资料、骨折愈合情况、膝关节功能评分及末次随访时膝关节功能优良率,并探索影响临床结果的因素。[结果]所有患者手术顺利,平均手术时间(98.32±19.64) min,平均术中出血量(73.24±17.59) ml,未发生血管、神经损伤、切口感染等严重并发症。所有患者随访(14.61±2.50)月,骨折平均愈合时间(3.42±0.84)月,完全负重时间(4.72±0.41)月。术后6个月及末次随访时比较患者Lysholm评分和HSS评分差异均无统计学意义(P>0.05),但两时间点间,膝屈伸活动度有显著改善(P<0.05)。影像评估方面,术后骨折复位良好,力线恢复正常,术后即刻、术后6个月及末次随访时患者平台内翻角度、内侧平台后倾角、外侧平台后倾角差异均无统计学意义(P>0.05)。末次随访时患者Lysholm评分优良率为81.54%(53/65),HSS评分优良率为86.15%(56/65),年龄≤50岁、单纯后柱骨折、未合并半月板损伤患者的Lysholm评分和HSS评分优良率显著高于年龄>50岁、合并侧柱骨折及合并半月板损伤的患者,差异有统计学意义(P<0.05)。[结论]对于胫骨平台后柱骨折患者,后侧入路T形支撑钢板内固定治疗疗效满意。但是,高龄、合并侧柱骨折及半月板损伤为恶化临床效果的因素。更多还原

【Abstract】 [Objective] To explore the clinical outcomes of T-shaped supporting plate through posterior approach for treatment of posterior column fracture of tibial plateau. [Methods] From Jan. 2014 to Jan. 2017, a total of 65 patients who underwent surgical treatment for posterior column fracture of tibial plateau in our hospital were included into this study. All the patients received open reduction and internal fixation with T-shaped supporting plate through posterior approach. The data were retrospectively analyzed, including those during perioperative period, fracture healing, knee function score and the excellent and good rate of knee function. In addition, the factors affecting knee function were explored. [Results] All the patients had operation conducted smoothly, with operation time of(98.32±19.64) min and intraoperative bleeding volume of(73.24±17.59) ml on average,without serious complication, such as neurovascular injuries and wound infection in anyone of them. All the patients who were followed up for(14.61±2.50) months on average, achieved clinical fractures healing in an average of(3.42±0.84) months, and returned to complete weight-bearing in an average of(4.72±0.41) months. The knee flexion-extension range of motion significantly improved at the latest follow up compared with that at 6 months postoperatively(P<0.05), although no significant differences were proved regarding to the Lysholm and HSS scores between the two time points(P>0.05). In term of radiographic evaluation,satisfactory fracture reduction and normal articular alignments were obtained in all the patients, without significant differences in tibial plateau-tibial shaft angle(TPTSA), posterior slopes of medial tibial plateau and lateral tibial plateau among the time points of immediately after operation, 6 months postoperatively and the latest follow up(P>0.05). At the latest follow-up, the excellent and good rate based on the Lysholm score and HSS score were 81.54%(53/65) and 86.15%(56/65) respectively, which in the patients aged less than 50 years, with simple posterior column fracture and without meniscus injury were significantly superior to those aged more than 50 years, accompanied with medial or lateral column fractures and meniscus injuries correspondingly(P<0.05). [Conclusion] This Tshaped supporting plate through posterior approach internal fixation is effective for posterior column fracture of tibial plateau.However, the advanced age, accompanied with medial or lateral column fracture and meniscus injuries are the factors deteriorating the clinical consequences更多还原