改良后内侧、后外侧入路治疗胫骨平台后髁骨折

Modified posteromedial and posterolateral approaches for the treatment of posterior tibial plateaufractures

目的探讨改良后内侧、后外侧入路治疗胫骨平台后髁骨折的疗效。方法对2006年1月至2011年10月收治且获得随访的25例胫骨平台后髁骨折患者资料进行回顾性分析，男17例，女8例；年龄22-76岁，平均46．4岁。骨折按AO／OTA分型：41-B1型4例，41-B2型6例，41-B3型15例；按Luo等提出的三柱分型均为后柱骨折。10例胫骨平台后外侧髁骨折患者采用改良后外侧入路，15例胫骨平台后内侧髁骨折患者采用改良后内侧人路，后方骨折使用支撑钢板固定。末次随访时根据美国特种外科医院（HSS）膝关节评分系统评定膝关节功能恢复情况。结果25例患者术后获平均13．2个月（10-24个月）随访。术后即刻骨折复位质量Rasmussen评分为13-18分，平均16．5分；其中优20例，良4例，可1例，优良率为96．O％。25例患者完全负重下无疼痛感，X线片爪骨折均获愈合，愈合时间平均为13．9周（12-18周）。未见血管、神经损伤等手术相关并发症发生。未次随访时HSS膝关节评分平均为91分（74．97分），其中优17例，良8例，优良率为100％。膝关节活动度为0-125。。结论对于胫骨平台后髁骨折，改良后内侧、后外侧入路能较好地暴露骨折部位，且允许直视下复位骨折和采用后方支撑钢板固定骨折，对周围软组织损伤较小，术后功能恢复良好。

Objective To observe the clinical outcomes of modified posteromedial and posterolateral approaches for the treatment of posterior tibial plateau fractures. Methods Between January 2006 and October 2011, 25 patients with posterior tibial plateau fracture were identified. They were 17 men and 8 women, aged from 22 to 76 years （average, 46.4 years） . According to the AO/OTA classification, there were 4 cases of type 41-B1, 6 cases of type 41-B2 and 15 cases of type 41-B3. According to Luo＇s three-column classification, they were all posterior column fractures. Ten patients with posterolateral tibial plateau fracture were treated by the modified posterolateral approach and the other 15 patients with postero- medial tibial plateau fraeture by the modified posteromedial approach. The posterior fractures were fixated with a buttress plate. The knee function was evaluated at the last follow-up by the The Hospital for Special Surgery （HSS） Score. Results All the 25 cases were followed up for a mean time of 13.2 months （from 10 to 24 months）. By the radiological Rasmussen criteria for fracture reduction, the mean score immediately after surgery was 16. 5 points （from 13 to 18 points）, with 20 excellent cases, 4 good cases and one fair case. All patients were pain-free with full range of motion. Radiologieally, bone union was achieved in all eases after a mean time of 13.9 weeks （from 12 to 18 weeks）. No surgery-related complications were found. The mean HSS score was 91 points（range, 74 to 97 points） and the good to excellent rate was 100% （ 17 excellent and 8 good cases） at the last follow-up. The average range of knee motion ranged from 0° to 125°. Conclusion In the treatment of posterior tibial plateau fractures, because the modified posteromedial and posterolateral approaches can result in excellent fracture reduction under direct visualization and allow for posterior buttress plating, soft tissues can be well preserved and good functional results can be expected.