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1、中国修复重建外科杂志2006年第20卷第7期·695·复杂胫骨平台骨折手术入路的探讨方跃池雷霆王光林杨天府【摘要】目的评价双切口入路治疗复杂胫骨平台骨折手术治疗方法及疗效。方法2003年5月～2004年11月,手术治疗复杂胫骨平台骨折24例,其中男16例,女8例。年龄21～65岁,平均40.6岁。左侧11肢,右侧14肢,1例为双侧,均为闭合性骨折。致伤原因:高处坠落伤10例,交通伤12例,其他2例。按照Schatzker分型标准:Í型14肢,Î型11肢。受伤至手术时间6～15d,平均10.4d,均采用
2、双切口入路,双钢板固定手术治疗。结果所有患者均获随访12～23个月,平均15.6个月。术后骨折愈合时间6～9个月,平均7.4个月。其中2肢因关节面粉碎严重未达到解剖复位;1肢因干骺端粉碎严重未恢复下肢正常力线,出现膝内翻;3肢出现伤口表皮坏死,无骨外露,经换药处理后愈合。膝关节功能按Rasmussen评分标准评定:优10肢,良8肢,可3肢,差4肢。结论双切口入路降低了软组织的并发症,有利于关节面复位;双钢板固定可靠,可早期行功能锻炼,是一种较好的治疗复杂胫骨平台骨折的手术入路和方法。【关键词】胫骨平台
3、骨折内固定手术入路中图分类号:R683142R68713文献标识码:AEXPLORATIONOFSURGICALAPPROACHESOFCOMPLEXTIBIALPLATEAUFRACTURESöFANGYue,CHILeiting,WANGGuanglin,etal.DepartmentofOrthopaedics,WestChinaHospitalofSichuanUniversity,ChengduSichuan,610041,P.RChinaCorrespondingauthor:YANGTi
4、anfu,E2mail:yangtianf@126.com【Abstract】ObjectiveToevaluatethesurgicaltreatmentanditsresultsofcomplextibialplateaufractures.MethodsFromMay2003toNovember2004,24casesofcomplextibialplateaufracturesweretreatedbytwo2incisionapproaches.Therewere16males(includ
5、ing1caseofbilateral),and8females,withmeanageof40.6years(21265years),elevenfracturesoccurredinleftextremityand14intheright.Nopatientssufferedopenfractures.Fracturewascausedbyfallfromheightin10cases,bytrafficaccidentin12casesandbyanothercausesin2cases.Acc
6、ordingtoSchatzkerclassification,typeÍfracturewasfoundin14extremities,typeÎin11extremities.Allcaseswereoperatedwithtwo2incisionapproachesanddouble2platesfixation.Theoperationwasperformed6215daysafterinjurywithmean10.4days.ResultsAllcaseswerefollowedupfro
7、m12to23months(mean15.6months).Timeofthebonehealingwas629months,withmean7.4months.Noreductionofanatomywasachievedbecauseofcomminutedfracturesofarticularsurfacesin2limbs.Thelineofthelowerextremitydidnotrecoverbecauseofmetaphysiscomminutionin1limb,whichled
8、tokneevarus.Epidermalnecrolysiswasobservedin3limbs,andthewoundhealedafterchangedressing.ThefunctionofthekneewasevaluatedaccordingtoRasmussen'scriteria,theresultswereexcellentin10limbs,goodin8limbs,fairin3limbs,andpoorin4limbs.Con
