摘要目的 探讨改良前外侧腓骨头上入路内固定治疗胫骨平台后外侧髁骨折的临床效果。方法 将146例胫骨平台后外侧髁骨折患者按照手术入路方式的不同分为对照组(采用传统的后侧入路内固定治疗,73例)和观察组(采用改良前外侧腓骨头上入路内固定治疗,73例)。比较两组患者膝关节复位角度、骨折愈合时间、膝关节屈曲活动度、膝关节疗效评价和术后出现伤口感染、骨折不愈合、关节强直等并发症情况。结果 两组患者均获得随访,时间12~19个月,平均(15.48±3.87)个月。观察组患者膝关节复位情况明显优于对照组,且术后12个月较术后6个月明显降低。整个围手术期骨折愈合时间和膝关节屈曲活动度差异均存在统计学意义(P<0.01)。观察组骨折愈合时间明显短于对照组,而膝关节屈曲活动度则明显大于对照组。两组患者采用疼痛视觉模拟评分(visual analogue scale,VAS)显著减少,特殊外科医院膝评分(Hospital for Special Surgery,HSS)显著增加(P<0.05);观察组相应时间点VAS及HSS评分均显著优于对照组(P<0.05)。观察组的拉斯穆森功能评估优良率显著高于对照组(P<0.05)。两组的并发症发生率比较,观察组显著低于对照组(P<0.05)。结论 改良前外侧腓骨头上入路内固定术在治疗胫骨平台后外侧髁骨折中能够具有创伤小、暴露好、操作方便简单、术后恢复较快等优点,值得临床广泛推广。
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