改良前外侧入路治疗胫骨平台后外侧塌陷骨折

Treatment of depression fractures of posterolateral tibial plateau through a modified anterolateral approach

目的 ：探讨改良前外侧入路治疗胫骨平台后外侧塌陷骨折的疗效。方法 ：2011年2月至2013年1月,共收治13例单纯的胫骨平台后外侧塌陷骨折,男8例,女5例;年龄28~59岁,平均49.2岁。随访时检查膝关节功能,摄X线片,评估骨折愈合情况,记录随访过程中出现的并发症。采用Rasmussen放射学评分标准对骨折复位情况进行评估,根据末次随诊结果采用Rasmussen功能评分标准评定膝关节功能。结果：所有患者获随访,时间6~18个月,平均13.7个月;骨折愈合时间11~17周,平均15.1周。随访期间未见复位丢失,1例出现足背麻木,足背伸力及伸趾力减弱;1例出现切口红肿,少量淡黄色渗液,经扩大创口,引流换药后治愈。Rasmussen放射学评分13~18分,平均（16.50±0.67）分;Rasmussen功能评分13~30分,平均（25.20±2.21）分;膝关节活动度0°~135°,平均运动范围（125.3±9.3）°。结论：改良前外侧入路治疗胫骨平台后外侧塌陷骨折,暴露充分,复位及固定满意,不会出现血管神经损伤,术后膝关节稳定性及功能恢复好。

Objective ：To study the therapeutic effects of posterolateral depression fractures of the tibia1 plateau through a modified anterolateral approach. Methods：From February 2011 to January 2012,13 patients with posterolateral depression fractures of the tibial plateau were treated through a modified anterolateral approach. There were 8 males and 5 females ,rang- ing in age from 28 to 59 years old （49.2 years old on average）. Data from patients were collected retrospectively as follows：X- ray, time of fracture healing and the complications of fracture healing. The patients were evaluated both clinically and radiolog- ically according to the Rasmussen score system. Results：All the patients were followed up, and the duration ranged from 6 to 18 months （mean 13.7 months）. All the patients got bony union. The average radiographic bony union time was 15.1 weeks （ranged, 11 to 17 weeks）. No case of secondary articular depression was found. No complications such as malunion or joint stiffness were found. But 1 patient had superficial infection and 1 patient had common peroneal nerve injury. According to the Rasmussen score system,the mean radiological score was 16.50±0.67 （ranged, 13 to 18）,and the mean functional score was 25.20±2.21 （ranged, 13 to 30）. The mean range of knee motion was （ 125.3 ±9.3 ）° （ranged, 0~ to 135 ° ）. Conclusion： Treat- ment of depression fractures of posterolateral tibial plateau with a modified anterolateral approach is a safe method with effec- tive exposure, due to its stable fixation and relatively good outcome with minimal soft-tissue complications. It is regarded as an ideal procedure for depression fractures of posterolateral tibial plateau.