外侧扩大切口入路治疗胫骨平台后侧及外侧粉碎性骨折

Internal fixation of comminuted posterior/lateral condylar fractures of tibial plateau via expanded lateral incision

目的探讨外侧扩大切口入路治疗胫骨平台后侧及外侧粉碎性骨折临床疗效。方法回顾性分析2010年8月至2012年3月收治的16例胫骨平台后侧及外侧粉碎性骨折患者资料，男12例，女4例；年龄21。66岁，平均37．9岁；左侧5例，右侧11例；均为闭合性骨折。骨折根据CT三柱分型均为波及后侧柱和外侧柱的塌陷骨折；骨折按Schatzker分型：Ⅱ型9例，V型6例，Ⅵ型1例；骨折按AO／OTA分型：B3型9例，c1型6例，c2型1例。手术均采用侧卧漂浮体位、膝外侧扩大切口人路，自胭横纹内侧向外侧再经腓骨小头上方弧形向下至胫骨结节内侧，切口长12～15enl，经肌肉间隙显露胫骨整个外侧平台，直视下复位骨折并植骨内固定。结果16例患者均顺利完成手术，手术时间为52～110min（平均71．0min）；术后获6～18个月（平均13．0个月）随访。无血管、神经损伤及伤口感染等并发症发生；骨折均获骨性愈合，平均愈合时间为12周（10～14周），无骨折再塌陷及膝内、外翻畸形发生。末次随访时根据Rasmussen膝关节功能评分标准评定疗效：优10例，良4例，可2例。结论经膝外侧扩大切口入路治疗胫骨平台后侧及外侧粉碎性骨折，可于侧卧位实施手术，单一切口能较好地显露胫骨前外侧、后外侧、后内侧平台及腓骨小头，可直视下复位骨折并植骨内固定，手术损伤小、时间短且并发症少。

Objective To explore the surgical approach for internal fixation of comminuted poste- rior/lateral condylar fractures of tibial plateau. Methods Sixteen consecutive patients with comminuted posterior/lateral condylar fractures of tibial plateau were admitted to our department from August 2010 to March 2012. They were 12 males and 4 females, with an average age of 37.9 years （from 21 to 66 years）. All cases were closed fractures, involving 5 left sides and 11 right sides. They were all collapsed fractures involving posterior/lateral column according to the Three-Column classification based on CT scans. By the Schatzker classification, 9 cases were type l], 6 type V and one type VI; by the AO/OTA classification, 9 cases were type B3, 6 C1 and one type C2. Internal fixation was performed via expanded lateral incision when the patient was side lying. The incision was 12 cm long, starting from the medial to the lateral popliteal crease and then running above the fibular capitellum to the medial tubercle of tibia, to expose the whole lateral condyle of the tibial plateau in the intermuscular space. Results All the 16 patients were successfully operated on in a mean time of 71.0 min （from 52 to ll0 rain） . The follow-ups lasted from 6 to 18 months （average, 13.0 months）, revealing no neurovascular complications or wound infection. All obtained bony union after a mean time of 12 weeks （from 10 to 14 weeks）. No secondary collapse of tibial plateau or knee varus/valgus occurred. The postoperative knee function was excellent in 10 cases, good in 4 and fair in 2, according to the Rasmussen＇s scoring system. Conclusions The expanded lateral incision can expose well the anterolateral, posterolateral and medial-posterior aspects of the tibial plateau and the capitellum to facili- tate reduction and internal fixation when the patient lies in a lateral position. These will lead to limited in- vasion, less operative time and fine outcomes in the treatment of comminuted posterior/lateral condylar frac- tures of tibial plateau.