后外侧入路治疗胫骨平台骨折疗效分析

Clinical effect of posterolaterai knee approach for treatment of posterolateral tibial plateau frac- tures

目的探讨膝关节后外侧入路手术复位内固定治疗胫骨平台后外侧骨折的临床疗效。方法选择2006年1月-2009年7月采用后外侧入路手术治疗胫骨平台后外侧骨折患者32例，其中男19例，女13例；年龄27—70岁，平均38．1岁。致伤原因：交通伤19例，高处坠落伤9例，其他伤4例。合并伤：合并前交叉韧带损伤7例，均为胫骨平台止点撕脱。结果本组32例均获随访12—36个月，平均18．2个月。骨折全部愈合，无切口感染，无内固定松动或断裂，无膝关节内、外翻畸形或骨折再移位。1例患者术后出现腓总神经牵拉伤，用甲钴胺片保守治疗2个月后恢复。术后根据Rasmussen膝关节功能评定评分标准：优19例，良11例，可2例，差0例，优良率为94％。结论膝关节后外侧入路手术治疗胫骨平台后外侧骨折，有利于骨折的复位和固定，具有暴露清楚、内固定安放方便、创伤小及临床疗效好等优点。

Objective To discuss the clinical results of surgical reduction and fixation via pos- terolateral knee approach in the treatment of posterolateral tibial plateau fractures. Methods The study involved 32 patients with posterolateral tibial plateau fractures treated through posterolateral knee approaches from January 2006 to July 2009. There were 19 males and 13 females, at the age of 27- 70 years （mean, 38.1 years）. Injury causes included traffic injuries in 19 patients, high fall injuries in nine and other in four. There were seven patients combined with anterior cruciate ligament injuries, which was all tibial plateau insertion avutsion. Results All patients were followed up for 12-36 months （ mean, 18.2 months） , which showed bone union, without presence of incisional infection, loosening or breakage of screws, varus or valgus deformity of the knee, or fracture redisplacement. One patient had tension injury of common peroneal nerve postoperatively and recovered after two months conservative treat- ment of Methycobal. According to the Rasmussen knee function score, the results were excellent in 19 pa- tients, good in 11 and fair in two, with excellence rate of 94%. Conclusion Posterolateral knee ap- proach facilitates the reduction and fixation of posterolateral tibial plateau fractures and has advantages of clear exposure, convenient placement of internal fixation, small invasion and good clinical results.