本文選題：膝關(guān)節(jié)　切入點(diǎn)：脛骨平臺骨折　出處：《大連醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：背景:后外側(cè)脛骨平臺骨折在文獻(xiàn)中鮮有報(bào)道,但近年來隨著對關(guān)節(jié)內(nèi)骨折的CT平掃使用增加,發(fā)現(xiàn)這些骨折的發(fā)生率高于預(yù)期。由于脛骨平臺后外側(cè)區(qū)解剖結(jié)構(gòu)復(fù)雜,后外側(cè)柱骨折的暴露與固定頗有難度。此外,生物力學(xué)原則要求處理脛骨平臺骨折時(shí)應(yīng)達(dá)到關(guān)節(jié)的解剖復(fù)位,并在平臺后方加以抗滑支撐板固定。由于對于脛骨平臺后外側(cè)象限直視下操作難以實(shí)現(xiàn),往往無法通過外側(cè)或前外側(cè)入路實(shí)現(xiàn)此類骨折的復(fù)位與充分固定。Bhattacharyya描述了一種通過伸直位后側(cè)治療脛骨平臺后剪切骨折的入路。但此方法需要對內(nèi)側(cè)皮膚進(jìn)行廣泛游離,并分離腓腸肌內(nèi)側(cè)頭。Trickey介紹了乆窩中線S形切口,但為了手術(shù)視野清晰需要游離更大范圍的皮膚,更可能發(fā)生對腓腸神經(jīng)的損傷。由Lobenhoffer最初描述的標(biāo)準(zhǔn)后外側(cè)入路需要對腓骨頸截骨并解離脛骨平臺后外側(cè)區(qū),可能導(dǎo)致腓骨截骨不愈合,以及因?qū)M織的廣泛解離造成的軟組織創(chuàng)傷(關(guān)節(jié)囊和半月板(冠狀)韌帶)。Carlson報(bào)道了一種后外側(cè)S形入路,此法損傷性較小;然而,手術(shù)視野有限。Tao研究出改良型后外側(cè)L形皮膚切口入路,但對于復(fù)雜型的骨折,復(fù)位及釘板固定容易導(dǎo)致乆窩動(dòng)脈損傷。Chang提出一種改良型后外側(cè)入路,無需對腓骨近端背側(cè)進(jìn)行截骨,雖然此法對軟組織產(chǎn)損傷小,但因其難以向外擴(kuò)展,限制了手術(shù)范圍。為了克服上述問題,Frosch提出了改良型后外側(cè)入路。這種方法涉及外側(cè)關(guān)節(jié)切開從而看到關(guān)節(jié)表面,并且通過對平臺后外側(cè)解剖實(shí)現(xiàn)骨折的復(fù)位。此入路可保護(hù)后外側(cè)區(qū)域軟組織及重要韌帶。目的:本研究目的為回顧性評估與評價(jià)使用無腓骨截骨的改良型后外側(cè)入路外科治療后外側(cè)脛骨平臺骨折的結(jié)果。方法:回顧性分析我院2012年1月至2016年12月后外側(cè)脛骨平臺骨折患者并行改良型后外側(cè)入路切開復(fù)位內(nèi)固定術(shù)的患者共10例,并于進(jìn)行臨床評估。已排除病理性骨折,開放性骨折,骨筋膜室綜合征與下肢神經(jīng)血管損傷。收集患者手術(shù)前資料如年齡,性別,損傷機(jī)制,損傷部位,相關(guān)損傷和軟組織損傷的相關(guān)病史與數(shù)據(jù)。獲得所有患者的術(shù)前標(biāo)準(zhǔn)X線片,CT掃描和三維(3D)重建。采用AO/OTA分型對本研究中的所有骨折進(jìn)行分型。收集手術(shù)時(shí)間(天),手術(shù)時(shí)長(min),骨移植,術(shù)中復(fù)位等手術(shù)相關(guān)數(shù)據(jù)。最后,收集并評價(jià)患者術(shù)后相關(guān)數(shù)據(jù),如隨訪時(shí)間(月),骨折愈合時(shí)間(周),并發(fā)癥,運(yùn)動(dòng)范圍(ROM)和特殊外科醫(yī)院(HSS)膝蓋評分。結(jié)果:根據(jù)(AO/OTA)分型,其中為1例單純劈裂骨折,分型為41-B1.1,7例診斷為劈裂塌陷骨折,分型為41 B3.1骨折,1例診斷為關(guān)節(jié)多發(fā)性骨折,分型為41-C3.1,1例診斷為雙踝脛骨平臺后方骨折。本研究中包括7名男性和3名女性,平均年齡45歲(27至67歲)�；颊呔诮煌ㄊ鹿手惺軅９钦蹫�5例左膝關(guān)節(jié)骨折和5例右膝關(guān)節(jié)骨折.相關(guān)的骨骼損傷包括腓骨頭骨折,踝骨折,骨盆骨折,肩胛骨骨折,鷹嘴骨折和頂骨骨折。相關(guān)軟組織損傷包括瘀傷/挫傷,外側(cè)半月板損傷和前十字韌帶損傷。所有相關(guān)的骨與軟組織損傷均予以相應(yīng)處置。從骨折到手術(shù)的平均時(shí)間為10天(范圍:4至30天)。平均手術(shù)操作時(shí)間為153.3分鐘(范圍:120至240分鐘)。6名患者使用自體骨移植用于支撐塌陷性骨折。術(shù)后FTA平均值為172.70±2.35,MPTA的平均值為90.10±2.33,LPSA的平均值為10.00±2.66。隨訪期間測量上述放射學(xué)參數(shù)無顯著變化(p值0.05)。所有患者解剖復(fù)位均達(dá)到滿意效果。所有患者平均隨訪時(shí)間為18.8個(gè)月(范圍:6-40個(gè)月)。平均骨愈合時(shí)間為13周(范圍:11-14周),平均完全負(fù)重時(shí)間為12周。所有患者骨折均愈合良好。膝關(guān)節(jié)的平均運(yùn)動(dòng)范圍(ROM)為膝伸展1°(范圍:0°-5°),膝的平均屈曲為125.8°(范圍:120°-135°),最終隨訪時(shí)平均HSS得分為91.8分(范圍:85-96)。沒有特殊相關(guān)并發(fā)癥如常見的腓神經(jīng)受傷記錄。在隨訪期間無病例脫失。結(jié)論:改良型后外側(cè)入路實(shí)現(xiàn)了骨折部位的直接與完全暴露,有助于實(shí)現(xiàn)骨折的解剖復(fù)位和穩(wěn)定的內(nèi)固定。通過使用該改良型入路,可以獲得令人滿意的臨床療效和放射學(xué)結(jié)果。
[Abstract]:Background: posterolateral tibial plateau fractures are rarely reported in the literature, but in recent years, with the increased use of CT intra-articular fracture scanning, found the fracture incidence was higher than expected. The posterolateral tibial plateau area complex anatomical structure after exposure and fixation of lateral column fracture is quite difficult. In addition, the biomechanical principle requires treatment tibial plateau fractures should reach anatomical reduction of joint, and anti slide supporting plate is fixed on the rear platform. Due to the posterolateral tibial plateau under direct vision operation is difficult to achieve, often cannot pass through the lateral or anterolateral approach to achieve reduction of this kind of fracture and fixed.Bhattacharyya describes an extension through the posterior tibial the platform after the shear fractures approach. But this method requires the medial skin extensive free, and separation of the medial head of the gastrocnemius muscle.Trickey introduced people fossa midline S Incision, but in order to clear surgical field to a wider range of free skin, more likely to occur on sural nerve injury. Originally described by Lobenhoffer standard posterolateral approach to the fibular neck osteotomy and dissociation of posterolateral tibial plateau area, may cause the fibular osteotomy healing, and due to extensive dissociation the organization of the soft tissue trauma (meniscus and ligament (coronary)).Carlson reported a S - shaped posterolateral approach, the damage was small; however, the limited operative field.Tao study of modified posterolateral L shaped skin incision, but for complex fracture reduction and plate screw fixation people can easily lead to nest artery injury.Chang proposed a modified posterolateral approach, without the need for proximal fibular dorsal osteotomy, although this method of producing soft tissue damage, but because it is difficult to expand outward, limiting the scope of operation. In order to overcome For the above problems, Frosch proposed a modified posterolateral approach. This method involves the incision to see the articular surface of the lateral joint, and through the platform of posterolateral fracture. The anatomical reduction implementation approach can protect the posterolateral region of soft tissue and ligament. Objective: the purpose of this study was to retrospectively assess and evaluate the use of improved free fibular osteotomy of the posterolateral surgical treatment of posterolateral tibial plateau fractures. Methods: a retrospective analysis of our hospital from January 2012 to December 2016 after the lateral tibial plateau fracture patients underwent modified posterolateral approach to open reduction and internal fixation in patients with a total of 10 cases and clinical evaluation with excluded pathological. Fractures, open fractures, bone compartment syndrome and lower extremity vascular and nerve injury were collected. Preoperative data such as age, gender, injury mechanism, injury site, injury and soft tissue 鎹熶激鐨勭浉鍏崇梾鍙蹭笌鏁版嵁.鑾峰緱鎵，

本文編號：1568055