三柱分型理论在复杂胫骨平台骨折手术入路选择中的应用

摘要

Objective To apply three column fractal theory in selection of surgical approach for complex tibial plateau fracture. Methods Sixty patients with complex tibial plateau fracture were admitted from June 2012 to March 2015. Patients with three column fracturesas diagnosed on CT reconstruction were randomly divided into test group and control group with 30 cases in each. Patients intest group were treated with open reduction by posteromedial converse "L" approach and anterolateral approach in the floating position with plate internal fixation. Patients in control group were treated with ante- medial approach with plate internal fixation in the supine position. The indicators related to the operation, complication and therapeutic effect were compared between two groups. Results All fractures were healed in both groups. The operation time in test group was less than that in control group, the time of bed movement and the weight bearing time after the operation in test group were earlier than those in control group, the incidence of wound complications after surgery in test group were lower than those in control group (al P<0.05). There were no significant difference in intraoperative blood loss, postoperative drainage volume and fracture healing time between two groups (al P>0.05). The function of knee and Rasmussen score in test group were higher than those in control group (al P<0.05). Conclusion The treatment of complex tibial plateau fracture under the guidance of three column fractal theory can achieve remarkable clinical curative effect due to less soft tissue damage, ful exposure of fracture and combined incision in floating position.%目的：探讨应用三柱分型理论治疗复杂胫骨平台骨折的临床疗效和意义。方法选取2012年6月至2015年3月收治的复杂胫骨平台骨折患者60例，均为三柱骨折。其中观察组30例采取漂浮体位下前外侧入路联合膝关节后内侧“L”形入路切开复位钢板内固定，对照组30例采取仰卧位下取膝前正中切口切开复位钢板内固定，比较两组手术相关指标、并发症发生情况及治疗效果。结果观察组手术时间少于对照组，术后下床活动时间和术后负重时间早于对照组，术后创口并发症发生率低于对照组，两组比较差异均有统计学意义（均P＜0.05）；而术中出血量、术后引流量和骨折愈合时间两组比较差异均无统计学意义（均P＞0.05）；观察组Rasmussen评分及膝关节功能均优于对照组（均P＜0.05）。结论根据三柱分型理论指导治疗复杂胫骨平台骨折，采取漂浮体位联合切口，软组织损伤小，骨折手术显露充分，固定更符合生物力学原理，有利于患者术后早期开始功能锻炼，疗效确切，值得推广。