目的：对比分析后侧入路与前侧入路治疗胫骨平台后髁骨折的临床疗效。方法将2011年3月至2013年6月来本院治疗的80例胫骨平台后髁骨折患者按随机数字表法分为观察组（后侧入路）和对照组（前侧入路），统计并分析两组患者骨折愈合时间、术后骨折复位情况、膝关节功能HSS评分以及并发症发生情况。结果观察组愈合时间明显短于对照组，HSS评分明显高于对照组，复位良好率高于对照组，以上各项差异均具有统计学意义（均P ＜0．05）；术后内固定松动或断裂的发生例数明显低于对照组，差异有统计学意义（ P ＜0．05）。结论后侧入路治疗胫骨平台后髁骨折具有愈合快、复位效果好、功能状态恢复好以及并发症发生例数少等优点，是一种安全有效的治疗方式。
Background：Roughly focused extracorporeal shock waves therapy （ESWT） is characterized by a wide focal area,a large therapy zone,easy positioning,and less pain during treatment.The purpose of this study was to investigate the effects of roughly focused ESWT on the expression of osteoprotegerin （OPG） and bone morphogenetic protein-2 （BMP-2） in osteoporotic fractures in rats.Methods：Seventy-two female Sprague-Dawley （SD） rats,3 months old,were divided into sham-operated group （n =6） and an ovariectomized （OVX） group （n =66）.Sixty OVX SD rats were used as a model of double proximal tibial osteotomy and inner fixation.The osteotomy site in the left tibia was treated with roughly focused ESWT once at an energy density of 0.26 mJ/mm^2,60 doses/min,and 2000 pact quantities.The contralateral right tibia was left untreated and served as a control.Expression of OPG and BMP-2 in the callus of the osteoporotic fracture area was assessed using immunohistochemistry,real-time polymerase chain reaction （PCR）,and Western blotting analysis.Results：Bone mineral density （BMD） at the proximal tibia,femur,and L5 spine was significantly reduced after ovariectomy.BMD of proximal tibia was 12.9% less in the OVX group than that in the sham-operated group.Meanwhile,bilateral oophorectomy resulted in a lower trabecular bone volume fraction （BV/TV） in the proximal tibia of the sham-OVX animals.Three months after bilateral oophorectomy,BV/TV was 14.29% of baseline BV/TV in OVX legs versus 45.91% in the sham-OVX legs （P 〈 0.001）.These data showed that the SD rats became a suitable model of osteoporosis,3 months after they were OVX.Immunohistochemical analysis showed higher levels of BMP-2 and OPG expression in the treatment group than those in the control group.Compared with the contralateral controls,decreased expression of OPG and BMP-2 at 3 days after roughly focused ESWT,followed by a later increase at 7 days,was indicated by real-time PCR and Western blotting analysis.The OPG messenger RN
