前后联合入路治疗累及后外侧平台劈裂C型胫骨平台骨折

Combined anterior and posterior approaches for type C posterolateral shearing tibial plateau fractures

目的探讨前后联合入路治疗累及后外侧平台劈裂C型胫骨平台骨折的手术方法及临床疗效。方法 7例患者术前均经CT扫描及三维重建,均采用后路和前外侧联合入路后侧和前外侧支撑钢板固定。采用DeCoster评定标准评定骨折复位情况、测定胫骨平台内翻角和采用HSS法行膝关节功能评定。结果术后X线片检查示达到解剖复位5例,复位良好1例,差1例。1例发生膝内翻。7例均获随访,时间6～18(12±6)个月。骨折全部愈合,愈合时间14～16(15±1)周。胫骨平台内翻角术后1年和术后初次摄片无变化;膝关节功能HSS评分为78～90(80±4)分。结论前后联合入路并后侧入路支撑钢板固定是治疗累及后外侧孤立劈裂C型胫骨平台骨折的有效方法。

Objective To study the operative procedures and clinical outcomes of type C posterolateral shearing tibial plateau fractures using combined anterior and posterior approaches.Methods Seven cases who underwent posterolateral shearing tibial plateau fractures were performed computed tomography（CT）scans and three-dimensional CT reconstruction before operation.They were operated by antiglide plate via combined posterior and anteriolateral approaches.Fracture reductions were assessed according to the methods of DeCoster,the postoperative alignments and functional outcomes were assessed by tibial plateau angle and HSS knee outcome score respectively.Results Postoperative X-ray showed anatomic reduction in 5 patients,good reduction in 1 and poor in 1.One patient got varus deformity of knee joint.Seven patients were followed up for 6～18（12±6）months.All fractures got healing for 14～16（15±1）weeks.There was no significant change in tibial varus angle between the immediate and one year after operation follow-up radiographs.The knee function score of HSS was 78～90（80±4）.Conclusions Combined anterior and posterior approaches with antiglide plating provides a good clinical solution for type C posterolateral shearing tibial plateau fractures.