后外侧切口双钢板治疗胫骨平台外侧及后外侧髁骨折

Operative treatment with double plates for complex fracture of tibial plateau lateralis and posterolateral condylus by posterolateral incision

目的探讨后外侧切口双钢板治疗胫骨外侧平台伴后外侧髁骨折的手术方法及临床疗效。方法 2010年9月至2012年6月,采用后外侧切口双钢板治疗9例胫骨外侧平台伴后外侧髁骨折患者,男性6例,女性3例,平均年龄41.70岁,交通事故伤6例,高处坠落伤2例,重物砸伤1例,均为胫骨外侧平台伴后外侧髁骨折。术后采用Rasmussen膝关节功能和放射学评分法评估疗效,并观察神经损伤、皮肤坏死、切口感染等并发症出现情况。结果 9例患者均获得随访,时间4～19个月(平均12.11个月),骨折均愈合。术后Rasmussen膝关节功能评定评分标准:优5例,良3例,可1例,差0例,优良率为88.90%。术后Rasmussen放射学评分标准评价:优7例,良2例,可0例,差0例,优良率为100%。术后无神经损伤、皮肤坏死及切口感染,无内固定松动及断裂,无骨折不愈合及骨折再移位,无膝关节内外翻畸形。结论胫骨外侧平台伴后外侧髁劈裂塌陷骨折时,采用后外侧切口双钢板治疗,于直视下进行复位及固定,便于操作,术后近期疗效满意。

Objective To investigate surgical approaches and clinical efficacy of operative treatments for lateral tibial plateau with posterolateral condylar fracture by double plates via posterotateral incision. Methods From September 2010 to June 2012, 9 cases of lateral tibial plateau with posterolateral condylar fracture were treated with double plates via posterolateral incision. There were 6 males and 3 females with the average age of 41.70 years old. There were 6 cases with traffic accident injury, 2 cases with falling injury and 1 case with bruising lateral condyle fracture. Among all patients, the causes were traffic accidents （ n = 6）, falls （n = 2） and bruising （ n = 1 ）. We assessed the efficacy and observed the nerve injury, skin necrosis and infection of incisional wound and other complications according to Rasmussen＇s func- tional grading system and Rasmussen＇s anatomical grading system. Results All patients were followed up for an average of 12.11 months （ ranged 4 to 19 months）. All the cases had their fractures healed. According to the Rasmussen functional scoring, the results were excellent in 5, good in 3 and fair in 1, and the excellent and good rate was 88.90%. The radiological results were graded with the Rasmussen score to evaluate the reduction of fracture. The outcome was excellent in 7 and good in 2, and the excellent and good rate was 100%. No nerve injury, skin necrosis, infection, screw loosening/breakage, fracture re - displacement or knee varus/valgus was found postoperatively. Bony union was achieved in all cases. Conclusion Double plates via posterolateral incision approaches are easier to manipulate for lateral tibial plateau with posterolateral condylar split depression fracture, which is under direct vision and fixation. There is great patient＇s satisfaction with the short term postoperative results.