经后内侧入路锁定接骨板固定治疗胫骨平台后侧骨折

Treatment of posteromedial tibial plateau fracture with locking plate internal fixation through posteromedial approach

目的探讨经膝关节后内侧入路锁定接骨板固定治疗胫骨平台后侧骨折的临床疗效。方法对23例胫骨平台后侧骨折患者采用经膝关节后内侧入路显露骨折,行锁定接骨板固定。对2例合并严重前外侧平台骨折者加用前外侧入路予以复位固定;对关节面塌陷者予以自体髂骨植骨。术后早期膝关节康复锻炼。结果患者切口均一期愈合。1例术后并发腘静脉血栓,予以抗血栓治疗后治愈。无其它并发症发生。患者均获随访,时间12～36个月。术后12个月根据膝关节HSS评分标准评定:优17例,良4例,可2例。结论对胫骨平台后侧骨折采用后内侧入路、锁定接骨板内固定疗效满意。手术入路的正确选择、关节面骨折的解剖复位、坚强有效的内固定是手术成功的关键。

Objective To study the clinical effect of locking plate internal fixation for posteromedial tibial plateau fracture through posteromedial approach. Methods 23 cases of posterior tibial plateau fracture were exposed and fixed with locking plate through posteromedial approach. Serious anterolateral tibial plateau fracture were involved in 2 cases and were fixed with locking plate. The cases with plateau depression were bone grafted with autologous iliac bone. All patients received early post-operative rehabilitation. Results All wounds achieved healing by first intention. One case complicated popliteal vein thrombus after operation, and got thrombus recanalization after anti-thrombosis medication. No other complication was found. All cases were followed up for 12 - 36 months. According to Hohl system score to knee joint function, 17 patients got excellent results, 4 good, and 2 fair. Conclusions The therapeutic effects of locking plate internal fixation for posterome＇dial tibial plateau fracture through posteromedial approach were satisfying. The correct choices of operative approach, anatomic reduction of articular surface fracture, stable and effective internal fixation are the key points of operation.