后内侧入路联合前外侧入路治疗胫骨平台后内髁劈裂伴外侧髁压缩骨折

Posteromedial and anterolateral approaches for posteromedial condylar tibial plateau split fracture combined with lateral compartment depression

目的 探讨仰卧位后内侧入路联合前外侧入路治疗胫骨平台后内髁劈裂伴外侧髁压缩骨折的疗效.方法 回顾性分析2011年2月-2013年3月收治的胫骨平台后内髁骨折伴外侧髁骨折患者48例,其中男37例,女11例;年龄15 ～ 67岁,平均42.5岁.左侧31例,右侧17例.受伤至手术时间5～16d,平均8.7 d.均采用仰卧位后内侧入路联合前外侧入路,后内髁劈裂骨折采用重建钢板或“T”形钢板,外侧髁压缩骨折采用解剖钢板或锁定钢板,外侧关节面塌陷骨缺损明显时取自体髂骨植骨.结果 本组手术时间2～3.5 h,平均2.8 h;住院时间12～45 d,平均21 d.所有患者随访时间5～25个月,平均12.8个月.骨折愈合时间4～8个月,平均6.7个月.术后即刻Rasmussen影像学评分16～18分,平均16.9分.8个月骨折愈合后美国特种外科医院（hospital for special surgery,HSS）膝关节功能评分76 ～ 95分,平均86.4分,其中优27例,良16例,中4例,差1例,优良率为90％.末次随访时,患者膝关节活动度平均为-5°～ 135°.患者伤口均Ⅰ期愈合,未出现血管神经损伤,无内固定松动、断裂等并发症发生.随访期间,1例膝关节伸直受限,膝关节活动20°～130°;1例骨性关节炎,经非手术治疗好转.结论 对于胫骨平台后内髁劈裂伴外侧髁压缩骨折,宜采用仰卧位后内侧入路联合前外侧入路,操作简便、复位满意、固定可靠,软组织并发症少,术后疗效满意.

Objective To evaluate the clinical results of posteromedial supine approach plus anterolateral approach for treatment of posteromedial condylar tibial plateau split fracture combined with lateral compartment depression.Methods A retrospective analysis was done on 48 cases of posteromedial condylar tibial plateau split fracture with lateral compartment depression operated through posteromedial supine plus anterolateral approaches from February 2011 through March 2013.There were 37 men and 11 women,aged 15-67 years （mean,42.5 years）.Fracture occurred at the left side in 31 cases and at the right side in 17 cases.Interval between injury and operation ranged from 5 to 16 days （mean,8.7 days）.Reconstructive or T-shaped plates were used for posteromedial condylar split tibial plateau fracture.Anatomical or locking compression plates were used for lateral compartment depression,but autogenous ilium bone grafting was performed laterally when bone defect was obvious.Results Average operation time was 2.8 hours （range,2-3.5 hours） and average length of stay was 21 days （range,12-45 days）.All cases were followed up for mean 12.8 months （range,5-25 months）.All fracture healed from 4 to 8 months （mean,6.7 months）.Mean Rasmussen score for radiological results was 16.9 points （range,16-18 points） immediately after operation.Hospital for special surgery （HSS） knee score averaged 86.4 points （range,76-95 points） 8 months after bone healed,indicating the excellent results in 27 cases,good in 16 cases,fair in 4 cases and poor in 1 case with a good to excellent rate of 90%.At the last follow-up,postoperative knee range of motion averaged-5°-135°.All incisions healed primarily without vascular nerve injury and implant loosing or breakage.There was an extension lag in 1 case with knee range of motion of 20°-130° and osteoarthritis in 1 case,but both were improved with non-operation therapy.Conclusion Posteromedia] supine plus anterolateral approaches are suitable for posteromedial condylar tibial plateau split fracture with lateral compartment depression,for the combined approaches gain advantages of easy operation,good reduction,rigid fixation,few soft-tissue complications and satisfactory clinical results.