【作者】 王磊；

【导师】 周业金；

【作者基本信息】 安徽医科大学 ， 外科学（骨外）， 2021， 硕士

【摘要】 目的:探索在成人单纯后外侧胫骨平台骨折的治疗中,腓骨颈截骨入路与胫骨平台后外侧入路这两种不同入路方式的治疗效果,综合比较二者各方面差异,以便于更加明确地指导临床工作。方法:我们采取回顾性研究的方式,分析了自2017年8月至2020年5月间,在安徽医科大学第三附属医院(本部及滨湖院区)经过腓骨颈截骨入路或胫骨平台后外侧入路两种手术入路治疗的单纯后外侧胫骨平台患者43例。其中腓骨颈截骨入路20例,男12例,女8例;年龄分布于25～68岁,平均49.24±10.40岁。其中交通伤12例,高处坠落伤5例,其他伤3例,有同侧腓骨头或腓骨颈骨折7例。后外侧入路23例,男13例,女10例;年龄分布于21～70岁,平均43.61±11.53岁。交通伤17例,高处坠落伤3例,其他伤3例,合并同侧腓骨头或腓骨颈骨折0例。根据设定的分组,对比两组的手术所用时间(min)、手术中出血量(ml)、达到骨性愈合的时间(周)、膝关节术后功能评分(Lysholm)、胫骨平台骨折复位评分(Rasmusse)、术后并发症等了解手术效果。结果:依据我们纳入符合条件的患者病例,均获得了完备的随访影响学资料并测得相应数据及膝关节功能评分,随访的时间12到18个月。其中纳入研究对象的手术病例中,所有病例均未发现内固定松动或者失效断裂的情况,内固定装置生物相容性好。比较二者的手术所耗用时间,我们发现,腓骨颈截骨入路组耗费的手术时间平均为85.92±18.63(min),后外侧入路组耗费的时间为84.83±15.91(min),由此可见,两组手术所需要的时间上相近,无明显差异(p>0.05),两组的手术出血量也无明显差异(p>0.05)。在并发症的比较上,后外侧组出现3例切口感染并发症,经过后期换药处理,均达到Ⅰ期愈合标准,截骨组没有发生切口感染情况,后外侧入路组发生胫前血管损伤3例,骨折延迟愈合1例,经定期随访术后第10月达临床骨性愈合标准。其中腓骨颈截骨入路组发生腓骨颈截骨处骨折延迟愈合1例;在并发症比较上,后外侧组较多,差异有统计学意义(p<0.05)。在术后3个月,膝关节Lyscholm功能评分上,无明显差异(p>0.05),在患肢膝关节术后3个月的胫骨平台骨折复位评分(Rasmusse)上,截骨组(17.53±0.52),比后外侧组(16.63±1.35)高,有统计学意义(p<0.05)。结论:据我们的研究与胫骨平台后外侧的手术入路相较而言,腓骨颈截骨入路可将腓骨小头向后上翻转直接暴露胫骨平台后外侧骨折块,使胫骨平台后外侧盲区的关节面显露更加充分,较大的操作空间可直视下更好的复位与选择适宜的内固定装置并放置在恰当的位置,但会耗费一定的手术时间,带来更大的创伤。胫骨平台后外侧入路造成的手术创伤较小,手术所耗时间相对也短,但术中对骨折端和膝关节面的显露,较腓骨颈截骨入路组差。因此单纯后外侧胫骨平台骨折合并同侧腓骨颈骨折时,腓骨颈截骨入路是较好的选择。更多还原

【Abstract】 Objective To explore the therapeutic effects of fibular neck osteotomy and posterolateral tibial plateau approach in the treatment of adult posterior lateral tibial plateau fracture,and to comprehensively compare the differences between them in various aspects,so as to guide the clinical work more clearly.Methods We adopt the method of retrospective study,a total of 43 patients with simple posterolateral tibial plateau who were treated by either the fibular neck osteotomy approach or the posterolateral tibial plateau approach in the Third Affiliated Hospital of Anhui Medical University from August 2017 to May 2020 were analyzed.Among them 20 cases were fibular neck osteotomy approach and 7 cases of ipsilateral fibular head or neck fracture.Posterolateral approach was used in23 cases.According to the set group,compared two groups of operation used time(min),intraoperative blood loss(ml),achieve bony healing time(week),knee functional score(Lysholm),postoperative fracture of tibial plateau score(Rasmusse),and postoperative complications after surgery.Results According to the cases of eligible patients included in our study.The follow-up time was 12 to 18 months.Among the surgical cases included in the study,no loosening or failure of the internal fixation was found in all cases,indicating good biocompatibility of the internal fixation device.Comparison the elapsed time of surgery,we found that the fibula neck bone cutting into the road group takes the average operation time was 85.92±18.63(min)and the posterolateral approach group time was 84.83 ±15.91(min),thus it can be seen,two groups of surgery on the time required to close(p > 0.05),surgical blood loss no difference(p > 0.05).There were more complications in the posterolateral group(p <0.05).There was no significant difference in Lyscholm functional score of knee joint 3 months after surgery(P>0.05).The reduction score of tibial plateau fracture(Rasmusse)3 months after surgery was higher in the osteotomy group(17.53±0.52)than in the posterolateral group(16.63±1.35)(P <0.05).Conclusion Both the fibular neck osteotomy and posterolateral tibial plateau approachcan effectively treat posterolateral tibial plateau fractures,but the fibular neck osteotomy approach can achieve better reduction and reduce the incidence of postoperative complications.Thereforeit is necessary to comprehensively select the appropriate approach depend on the fracture situation of physicians.更多还原