胫骨平台后髁骨折前方入路手术治疗的影像及临床分析

Radiological and clinical study of anterior approach for posterior tibial plateau fractures

目的分析胫骨平台后髁骨折的影像学特征,探讨前侧入路手术治疗胫骨平台后髁骨折的可行性及临床疗效。方法51例胫骨平台后髁骨折采用影像学检查分析骨折块大小,骨折线的角度以及合并膝关节内韧带、半月板等损伤情况。单纯后内侧骨折21例采用前内侧切口复位内固定,单纯后外侧骨折16例采用前外侧入路钢板结合拉力螺钉内固定,后内侧合并后外侧平台骨折14例采用前外侧切口结合前内侧切口或前正中切口外侧支撑钢板加内侧拉力螺钉或钢板内固定。结果 49例一期完成手术,手术时间平均95（50-160）min。51例均获随访8-48个月,平均21.5个月。末次随访时,Rasmussen影像学评分：优25例,良19例,可5例,差2例,优良率86.3%;Rasmussen功能评分：优13例,良28例,可5例,差5例,优良率80.4%。结论不同类型的胫骨平台后髁骨折具有影像学特异性,经前侧入路手术治疗胫骨平台后髁骨折具有可行性,并可同时处理合并的关节内软组织损伤,可获得良好的临床疗效。

Objective To investigate the radiological characteristics of posterior tibial plateau fractures and feasibility and clinical efficacy of anterior approach for the fractures. Methods A total of 51 patients with posterior bicondylar tibial plateau fractures were enrolled in the study. The fracture block size, angle of the fracture line and merge inside the knee ligament and meniscus injury were analysized through imaging examination. Twenty one cases of simple posteromedial fracture were reduced and fixed from the anteromedial incision, 16 cases of simple posterolateral fracture were fixed by lateral plate combined with screw from anterolateral approach, 14 cases of posteromedial were fixed by lateral supporting plate and medial screw or plate through anterolateral incision combined with medial incision or through the midline incision. Results Forty nine cases finished their operations in one stage with operation time on average 95 min（50-160 min）. Fifty one cases were followed up for 8-48 months, an average of 21.5 months. At the time of the last follow-up, Rasmussen imaging score： excellent in 25 cases,good in 19 cases, passable in 5 cases and worse in 2 cases, the excellent and good rate was 86.3%; Rasmussen function score：excellent in 13 cases, good in 28 cases, passable in 5 cases, worse in 5 cases, the excellent and good rate was 80.4%.Conclusion The different types of posterior tibial plateau fractures have specific imaging features, treatment of posterior tibial plateau fractures via anterior approach is feasible. Combined intra-articular soft tissue injuries can be treated simultaneously. A good clinical efficacy is achieved.