经后外侧入路治疗胫骨外侧平台单纯后侧、后外侧骨折的初步报告

Treatment of simple posterior and posterolateral fractures of the lateral tibial plateau via a postero-lateral approach

目的探讨胫骨外侧平台单纯后侧、后外侧骨折的损伤机制及介绍采用自行设计的后外侧入路进行治疗的经验。方法自2007年5月至2007年10月，采用自行设计的后外侧入路治疗少见的胫骨外侧平台单纯后侧、后外侧骨折的患者6例。根据AO分型：41-B-2．2．4型即胫骨外侧平台后侧塌陷性骨折2例，41-B-3．1．2型即胫骨外侧平台后外侧塌陷劈裂性骨折4例。采用T型支撑钢板治疗4例，L型支撑钢板治疗2例。结果术后X线片检查示所有患者均达到解剖复位，6例术后随访15～37周，平均26．3周。随访3个月时X线片示骨折均已愈合，未见高度丢失，Rasmussen放射评分16～18分，平均17．3分。膝关节总伸屈度100°-135°，平均120°。膝关节功能HSS评分为85～95分，平均89．3分。结论胫骨外侧平台后侧、后外侧髁骨折是膝关节屈曲且在不同程度外翻状态下受到轴向暴力所致，而后外侧入路是治疗这种类型骨折较为理想的手术入路，具有暴露清楚、内固定安放方便、创伤小以及临床疗效好等优点。

Objective To discuss treatment of uncommon simple posterior and posterolateral fractures of the lateral tibial plateau via a self-designed posterolateral approach. Methods From May 2007 to October 2007, 6 patients with simple posterior and posterolateral fractures of the lateral tibial plateau were treated via a self-designed posterolateral approach. They were 4 males and 2 females, with a mean age of 49.8 years （range, 36 to 57） . According to the AO classification system, 2 of them were posterolateral tibial plateau depression （41-B-2.2.4）; the other 4 were posterolateral tibial plateau split depression （41-B-3.1.2）. In 4 cases we used ＂T＂ type buttress plates, while the ＂L＂ type buttress plates were used in the other 2 cases. Results X-ray examinations showed that all the cases obtained anatomic reduction. The patients were followed up for 15 to 37 weeks, with a mean period of 26. 3 weeks. The fractures were all healed and no height loss was found. The mean Rasmussen score was 17.3 points（range, 16 to 18）. At the latest follow-up, the average ROM of the affected knee joints was 120°（range, 100°to 135°）, and the mean HSS （The Hospital For Special Surgery） score was 89.3 points（range, 85 to 95）. Conclusions Simple posterior and posterolateral fractures of the lateral tibial plateau usually result from direct axial compression, with the knee joint at a valgus moment. The posterolateral approach is ideal for these fractures, because of good exoosure, convenient olacement of the buttress plate, limited invasion and the excellent clinical results.