胫骨后侧平台骨折的治疗

Posteromedial and posterolateral knee approaches in treatment of posterior condylar tibial plateau fractures

目的探讨膝后外、后内入路治疗胫骨平台后髁骨折的临床效果。方法7例胫骨平台后髁骨折患者中6例采用膝后外、后内入路直视下复位骨折，由后向前置入螺钉或钢板固定；1例非手术治疗。结果随访6—22个月。根据Merchant膝关节功能评分标准评定疗效：6例手术治疗者，优4例，良2例；非手术治疗者为可。未见关节面明显塌陷，无膝关节内、外翻畸形和创伤性关节炎等并发症。结论采用膝后外、后内入路治疗胫骨后侧平台骨折能充分地显露骨折面和骨折块，能准确地进行解剖复位和牢固固定，膝关节功能良好；而非手术治疗效果欠佳。

Objective To evaluate the clinical result of posteromedial and posterolateral knee approaches in treatment of posterior condylar tibial plateau fractures. Methods 6 cases out of 7 were treated with operative reduction under direct vision and fixation through posteromedial and posterolateral knee approach. Screw and plate were used to reconstruct stability of posterior condylar tibial plateau, while conservative treatment was applied in 1 case. Results The following up period was from 6 to 22 months. According to Merchant＇s scale, operative treatment 4 cases got excellent results, 2 good, and conservative treatment 1 case got fair. No joint surface collapse, traumatic knee osteoarthritis and varus or valgus of the knee was found. Conclusions Posteromedial and posterolateral knee approaches provide sufficient exposure for the posterior condylar tibial plateau fractures, which facilitate anatomic reduction and rigid fixation with expectation of good functional recovery. Conservative treatment is associated with suboptimal effect.