中国组织工程研究

中国组织工程研究 ›› 2016, Vol. 20 ›› Issue (17): 2511-2518.doi: 10.3969/j.issn.2095-4344.2016.17.011

• 骨科植入物 orthopedic implant • 上一篇    下一篇

T形锁定钢板经Carlson后外侧入路置入修复胫骨平台后外侧骨折：12个月随访评价

冯 冲1，贾代良2，雷学锋2，张 刚3，邢齐宁3   

  1. 1济宁医学院2013级研究生，山东省济宁市 272011；2济宁医学院第一临床学院，山东省济宁市 272011；3济宁医学院附属医院，山东省济宁市 272011
  • 收稿日期:2016-03-13 出版日期:2016-04-22 发布日期:2016-04-22
  • 通讯作者: 雷学锋，教授，主任医师，济宁医学院第一临床学院，山东省济宁市 272011
  • 作者简介:冯冲，男，1988 年生，山东省济宁市人，汉族，济宁医学院骨外科学在读硕士，主要从事创伤骨科方面的研究。
  • 基金资助:

    山东省自然科学基金(ZR2015HL027)

“T”-shaped locking plate for posterolateral tibial plateau fractures by Carlson posterolateral approach: 12-month follow-up

Feng Chong1, Jia Dai-liang2, Lei Xue-feng2, Zhang Gang3, Xing Qi-ning3   

  1. 12013 Postgraduate Student, Jining Medical University, Jining 272011, Shandong Province, China; 2First Clinical College of Jining Medical University, Jining 272011, Shandong Province, China; 3Affiliated Hospital of Jining Medical University, Jining 272011, Shandong Province, China
  • Received:2016-03-13 Online:2016-04-22 Published:2016-04-22
  • Contact: Lei Xue-feng, Professor, Chief physician, First Clinical College of Jining Medical University, Jining 272011, Shandong Province, China
  • About author:Feng Chong, Studying for master’s degree, 2013 Postgraduate Student, Jining Medical University, Jining 272011, Shandong Province, China
  • Supported by:

     the Shandong Provincial Natural Science Foundation, China, No. ZR2015HL027

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摘要：

文章快速阅读：

 

文题释义：
Carlson后外侧入路：2005年Carlson首次提出经Carlson后外侧入路修复胫骨平台后外侧骨折。临床研究表明，该入路对胫骨平台边缘的骨折块的暴露更完全，在有充分手术操作空间的情况下，直视下对骨折进行解剖复位，而且不易对重要的血管神经等结构造成额外损伤，术后恢复好。
胫骨平台后外侧骨折：胫骨平台在形态学方面需要放在三维空间内认识，不能轻视胫骨平台后外侧部分对膝关节稳定的重要性，否则会造成术后关节功能不理想，甚至发生内固定失效。如果该型骨折未进行手术治疗，胫骨平台后外侧的骨性结构缺失或关节面存在严重塌陷，将导致膝关节外翻不稳，容易发生创伤性关节炎。因此手术处理胫骨平台后外侧已成为共识。
 
背景：单纯劈裂或压缩的胫骨平台后外侧骨折在临床中较为少见，合理选择修复该型骨折的手术入路和内固定物，对保证下肢力线正常和膝关节的稳定性，以及获得较好的生物相容性具有重要意义。
目的：比较Carlson后外侧和后正中两种入路置入“T”形锁定钢板修复胫骨平台后外侧骨折的稳定性和生物相容性。
方法：回顾性分析2011年7月至2014年7月济宁医学院附属医院收治的胫骨平台后外侧骨折患者43例，根据修复入路分为2组，Carlson后外侧入路组22例采用Carlson后外侧入路置入“T”形锁定钢板，后正中入路组21例经后正中入路置入“T”形锁定钢板。修复后对两组患者的围修复期数据、骨折内固定效果以及膝关节功能评分等进行比较分析。
结果与结论：①43例胫骨平台后外侧骨折患者(43膝)均获得随访。②两组患者的手术时间、骨折完全愈合时间、完全负重时间、治疗后12个月美国纽约特种外科医院评分、术后即刻与12个月后的胫骨平台内翻角及后倾角比较，差异均无显著性意义(P > 0.05)。③两组患者的骨折显露时间、出血量及治疗后12个月Rasmussen临床评分优良率比较，差异有显著性意义，Carlson后外侧入路组优于后正中入路组(P < 0.05)。④提示对于胫骨平台后外侧单一劈裂或者塌陷骨折，两种修复入路均能实现充分、直接的显露，而应用Carlson后外侧入路具有更好的修复效果、骨折固定效果和生物相容性。

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程
ORCID: 0000-0002-7510-6884(冯冲)

关键词: 骨科植入物, 骨植入物, 胫骨平台骨折, 后外侧, 内固定, 手术入路, 回顾性分析, 山东省自然科学基金

Abstract:

BACKGROUND: Single fracture or collapse of the posterolateral tibial plateau fractures is relatively rare in the clinical work. Rational choice of surgical approach and internal fixation for posterolateral plateau fracture is significant to restore the lower limb force line, maintain the joint stability and obtain good biocompatibility.

OBJECTIVE: To compare the stability and biocompatibility of Carlson posterolateral and posterior midline approaches for the treatment of posterolateral tibial plateau fractures with “T” shaped locking plate.
METHODS: From July 2011 to July 2014, 43 patients with posterolateral tibial plateau fractures, who were treated in the Affiliated Hospital of Jining Medical University, were retrospectively analyzed. All patients were assigned to two groups according to approaches. In the Carlson posterolateral approach group, 22 cases received “T”-shaped plate insertion by Carlson posterolateral approach. In the posterior midline approach group, 21 cases received “T”-shaped plate insertion by posterior midline approach. After repair, perioperative data, fixation effects and knee function score were compared and analyzed between both groups.
RESULTS AND CONCLUSION: (1) 43 cases (43 knees) of posterolateral tibial plateau fractures were followed up strictly. (2) No significant difference in operation time, fracture healing time, total load time, Hospital for Special Surgery score at 12 months postoperatively, tibial plateau angle and posterior slope angle immediately and 12 months postoperatively was detected between both groups (P > 0.05). (3) Significant differences in fracture exposure, blood loss, and excellent and good rate of Rasmussen at 12 months postoperatively were identified in both groups. Moreover, above indexes were better in the Carlson posterolateral approach group than in the posterior midline approach group (P < 0.05). (4) These findings confirmed that for a single fracture or collapse of the posterolateral tibial plateau fractures, two kinds of surgical approaches can achieve full and direct exposure. Carlson posterolateral approach has good repair effect, fixation effect and biocompatibility.
中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: Tibial Fractures, Internal Fixators, Follow-Up Studies, Tissue Engineering