【作者】 王积辉； 栾波；

【机构】 贵阳市第四人民医院；

【摘要】 目的讨后侧入路手术治疗胫骨平台后柱骨折的疗效及影响因素分析,为制订胫骨平台后柱骨折的手术方案提供依据。方法回顾分析17例胫骨平台后柱骨折患者的临床资料,均给予后侧入路手术治疗,定期随访骨折愈合时间、完全负重时间及愈合参数情况,同时分别采用HSS和Rasmussen膝关节功能评分评价术后12个月的膝关节功能及以上两评分与临床病理参数(年龄、性别、骨折类型、侧别、手术时间、半月板损伤及致伤原因)的关系。检测患者不同时间点的血清γ-谷氨酰转移酶(GGT)、碱性磷酸酶(ALP)、C-反应蛋白(CRP)水平及各观察点相对术前的变化情况。结果全组骨折均愈合,X线检查示愈合时间为(12.47±2.48)周,完全负重时间为(17.31±4.70)周;术后即刻、6及12个月的愈合参数的差异无统计学意义(P>0.05);HSS评分和Rasmussen评分分别为(83.48±7.50)分和(15.52±2.39)分,膝关节功能优良率分别为82.4%和88.2%;不同性别及骨折类型的HSS评分和Rasmussen评分的差异有统计学意义(P<0.05)。全组术前的血浆GGT、ALP和CRP分别为(77.61±21.40) U/L、(247.49±42.44) U/L和(40.64±9.72) mg/L,术后水平均降低,其术后1个月后的3指标变化程度均高于术后1周(P<0.05或0.01)。结论后侧入路手术治疗胫骨平台后柱骨折的疗效较好,可提高术后膝关节功能评分,同时改善血清生化指标,无严重并发症,可考虑进行推广。更多还原

【Abstract】 Objective To explore the clinical effect and influencing factors of surgical treatment on tibial plateau fracture involving the posterior column through posterior approach.Methods In a retrospective analysis,17 patients with tibial plateau fracture involving the posterior column were investigated.All patents were given surgical treatment through posterior approach.The fracture healing time,full weight-bearing time and healing parameters were followed up regularly.The HSS and Rasmussen knee function scores were employed to evaluate the knee function 12 months postoperatively.The relationships between knee function scores and clinicopathological parameters(age,sex,fracture type,lateralization,operative time,meniscus injury and cause of injury) were analyzed.The levels of γ-glutamyl transferase(GGT),alkaline phosphatase(ALP) and C-reactive protein(CRP) at different time were measured and the change related to the levels before operation were calculated.Results All fractures were healing with fracture healing time of(12.47±2.48) wks and full weight-bearing time of(17.31±4.70) wks.No significant differences of healing parameters were observed at immediate,6 and 12 months postoperatively.The HSS and Rasmussen scores were(83.48±7.50) and(15.52±2.39)with excellent rate of 82.4% and 88.2%,respectively.The above scores differ among different sex and types of fracture.The levels of serum GGT,ALP and CRP were(77.61±21.40) U/L,(247.49±42.44) U/L and(40.64±9.72)mg/L.Conclusions The clinical effects of surgical treatment on tibial plateau fracture involving the posterior column through posterior approach was better with improving knee function scores and serum biochemical parameters.更多还原