标题：后内侧倒“L”形入路治疗胫骨平台骨折疗效观察

      作者：王富明，陈小华，隆晓涛    中国科学院大学附属重庆医院·重庆市人民医院创伤骨科，重庆 400013

      卷次： 2019年30卷2期

      【摘要】 目的 总结并分析应用后内侧倒“L”形入路治疗累及后柱的胫骨平台骨折的临床效果。方法 回顾性分析2012年7月至2017年3月在重庆市人民医院创伤骨科采用后内侧倒“L”形入路治疗累及后柱的71例胫骨平台骨折患者的病例资料，其中男性42例，女性29例；根据Schatzker分型，Ⅱ型3例、Ⅲ型6例、Ⅳ型14例、Ⅴ型11例、Ⅵ型37例；根据“三柱理论”分型，单纯P型2例，P+M型7例，P+L型11例，P+M+L型41例。结果 71例患者获得12~21个月的随访，平均(16.8±2.1)个月；骨折愈合时间 14~24周，平均(16. 6±1.4)周；术后1年膝关节屈伸活动度为65°~140°，平均(114.6±6.3)°；术后Rasmussen放射学评价优良率为87.3% (62/71)，术后1年膝关节HSS评分优良率为85.9% (61/71)。结论 倒L形入路治疗胫骨平台骨折可以安全、有效暴露后柱，并获得满意临床疗效。
      【关键词】 胫骨平台骨折；倒L形入路；内固定；后柱；“三柱”理论
      【中图分类号】 R683.42 【文献标识码】 A 【文章编号】 1003—6350（2019）02—232—03C

linical effect of reversed L-shaped approach for tibial plateau fractures.
WANG Fu-ming, CHEN Xiao-hua, LONGXiao-tao. Department of Orthopedic Trauma, Chongqing General Hospital/Chongqing Hospital Affiliated to University ofChinese Academy of Sciences, Chongqing 400013, CHINA
【Abstract】 Objective To investigate the clinical outcomes of a posterior reversed L-shaped approach in thetreatment of tibial plateau fractures with posterior column. Methods The clinical data of 71 cases of tibial plateau frac-tures with posterior column (42 males and 29 females), who were treated with reversed L-shaped approach in Depart-ment of Orthopedic Trauma of Chongqing General Hospital from July 2012 to March 2017, were retrospectively ana-lyzed. According to Schatzker classification, there were 3 cases of type Ⅱ, 6 cases of type Ⅲ, 14 cases of type Ⅳ, 11cases of type Ⅴ, 37 cases of type Ⅵ. According to three-column classification: there were 2 cases of one-column frac-tures (type P), 18 cases of two-column fractures (7 cases of type P+M, 11 cases of type P+L), 41 cases of three-columnfractures (type P+M+L). Results After operation, all cases were followed up for 12 to 21 months, with a mean of(16.8±2.1) months. The average fracture healing time was (16.6±1.4) weeks (ranged, 14 to 24 weeks). One year after theoperation, the knee flexion ranged from 65° to 140°, with the average of (114.6±6.3)°. According the Rasmussen score,the excellent and good rate was 87.3% (62/71). The good outcome of knee HSS score at one year after operation was85.9% (61/71). Conclusion The reversed L-shaped approach in the treatment of tibial plateau fractures allows satisfiedvisualization of the medial and postero-lateral tibial plateau, which also has a satisfactory clinical outcome.
      【Key words】 Tibial plateau fractures; Reversed L-shaped approach; Internal fixation; Posterior column;Three-column classification·短篇论著·doi:10.3969/j.issn.1003-6350.2019.02.028基金项目：重庆市人民医院医学科技创新基金重点项目(编号：Y2016ZDXM06)