内侧加前外侧入路治疗胫骨平台三柱骨折

Medial plus anterolateral approaches for the treatment of tibial plateau fractures involving three columns

目的：探讨运用胫骨平台三柱分型,联合内侧加前外侧入路钢板内固定方法治疗复杂胫骨平台骨折的疗效.方法：2010年3月至2012年3月,采用内侧加前外侧入路,应用“T”形、“L”形钢板或桡骨远端“T”形钢板内固定治疗涉及胫骨平台三柱骨折,共20例.其中男13例,女7例;年龄29～52岁,平均39.4岁;受伤至手术时间8～12d,平均9d.末次随访按照美国特种外科医院膝关节功能评分方法评定疗效及测量胫骨平台的内翻角、后倾角、股胫角.结果：患者平均手术时间2.11h,术中出血量平均452ml,平均住院时间22.3d,20例术后均获随访,时间12～20个月,平均14.6个月.骨折愈合时间3～8个月,平均6.1个月.20例胫骨平台内翻角、后倾角、股胫角术后3d分别为（86.1±2.7）°、（10.7±1.6）°、（168.0±4.7）°,术后1年分别为（84.1±3.2）°、（13.7±1.9）°、（170.0±5.8）°,差异无统计学意义（P〉0.05）.末次随访按照美国特种外科医院膝关节功能评分方法评定疗效：优11例,良6例,中2例,差1例.术后无神经及血管损伤,术后1例出现局部感染,1例发生切口皮缘部分坏死,均经保守治疗痊愈.4例术后出现小腿内下方感觉麻木,无螺钉松动、断裂及内固定失效等其他并发症发生.结论：采用内侧加前外侧入路治疗胫骨平台三柱骨折能够术中不更换体位,术后获得更优良的解剖复位和更坚强的固定,有利于膝关节早期功能的锻炼.

Objective：To study surgical outcomes of medial plus anterolateral approaches for the treatment of tibial plateau fractures involving three columns.Methods：From March 2010 to March 2012,20 patients with tibial plateau fractures involving three columns were treated with internal fixation by using T-shape, L-shape plate,ordistal radius T-plate through medial plus anterolateral approaches.Among the patients, 13 patietns were male and 7 patients were female,ranging in age from 29 to 52 years old with an average of 39.4 years old.The intervals between injury and operation ranged from 8 to 12 days,with a mean of 9 days.At the latest follow-up,the American Hospital for Special Surgery score（HSS） was used to evaluate clinical effect,and the average loateau angle,posterior slope angle and femorotibial angle of tibia were measured on the X-ray films.Results：The average operation time was 2.11 hours;average intraoperative blood loss was 452 ml and average hospital stay was 22.3 days.All the patients were followed up,and the duration ranged from 12 to 20 months,averaged 14.6 months.The fracture healing time ranged from 3 to 8 months,with a mean of 6.1 months.The average loateau angle,posterior slope angle and femorotibial angle of tibia at 3 days afte roperation were （86.1±2.7）°,（10.7±1.6）° and （168.0±4.7）° respectively;and （84.1±3.2）°,（13.7±1.9）°,（1 70.0±5.8） ° respectively at 1 year after operation（P〉0.05）.According to HSS,11 patietns got anexcellent result,6 good,2 poor and 1 bad.There were no postoperaive neural and vascular injuries,no plate lossening or broken.One patient had local infection.One patient had skin flap partial necrosis and was cured by conservative treatment.Four patients had postoperative numbness below the insideleg.Conclusion：Medial pl us anterolateral approaches for the treatment of fractures involving three columns are effective to get good anatomic reduction and stable fixation without changing body position,which is helpful to early functional rehabilition of knee joint.