外后侧弧形切口双肌间隙入路治疗不同分型胫骨后外侧平台塌陷骨折

Arc incision via double spatium intermuscular approach in the treatment of different types of fracture of posterolateral tibial plateau

目的：探讨胫骨后外侧平台塌陷骨折采用外后侧弧形切口双肌间隙入路手术治疗的临床效果。方法笔者回顾性分析2011年7月～2013年7月收治的60例胫骨后外侧平台塌陷骨折患者的临床治疗及随访资料，根据Schatzker骨折分型分为：SchatzkerⅢ＋Ⅳ组28例，SchatzkerⅤ＋Ⅵ组32例，分别对两组患者的术中情况、术后效果指标进行统计分析。结果 SchatzkerⅢ＋Ⅳ组的手术时间、术中出血量均显著低于SchatzkerⅤ＋Ⅵ组（ P＜0．05），两组患者的切口长度、住院时间、骨折愈合时间指标差异不显著（ P＞0．05）；两组术后3d复位分布比较差异不显著（P＞0．05），复位优良率SchatzkerⅢ＋Ⅳ组96．43％高于SchatzkerⅤ＋Ⅵ组的90．62％但差异不显著（P＜0．05）。 SchatzkerⅢ＋Ⅳ组与SchatzkerⅤ＋Ⅵ组在术后3、6个月的Rasmussen、膝关节功能HSS评分差异不显著（P＞0．05），但SchatzkerⅢ＋Ⅳ组术后12个月、末次随访的Rasmussen、HSS膝关节功能评分显著优于SchatzkerⅤ＋Ⅵ组（ P＜0．05）。末次随访SchatzkerⅢ＋Ⅳ组患者的膝关节功能优良率为85．71％，高于SchatzkerⅤ＋Ⅵ组的75％，但差异不显著（ P＞0．05）。结论胫骨后外侧平台塌陷骨折患者采用外后侧弧形切口双肌间隙入路手术治疗能够取得较好的术后复位及功能恢复效果，同时SchatzkerⅢ＋Ⅳ组患者的术后膝关节功能恢复较SchatzkerⅤ＋Ⅵ组好。

Objective To investigate the clinical effect of arc incision via double spatium intermuscular ap-proach in the treatment of different types of fracture of posterolateral tibial plateau.Methods A retrospective anal-ysis of clinical treatment and follow-up data of 60 cases of posterior tibial bone fractures with lateral platform collapse at our hospital from Jul.2010 to Jul.2012 were carried out.According to Schatzker fracture type,all patients were divided into SchatzkerⅢ ＋Ⅳgroup（28 cases） and SchatzkerⅤ ＋VI group（32 patients）.Statistical data of in-traoperative performance and postoperative effects of patients in the two groups were analyzed.Results Operative time and blood loss of SchatzkerⅢ＋Ⅳ group were significantly lower than those in SchatzkerⅤ＋Ⅵ group（ P〈0.05 ） .The incision length,hospital stay,fracture healing time of two groups of patients had no significant difference （ P〉0.05） .There was no significant difference of reduction distribution at 3 days after operation in the two groups （ P〉0.05） .The excellent and good rate of reduction in SchatzkerⅢ＋Ⅳgroup was 96.43%,higher than that in the SchatzkerⅤ＋Ⅵ group（90.62%）,but the difference was not significant（P 〈0.05）.In the 3rd and 6th months,the Rasmussen and HSS score had no difference between Schatzker Ⅲ＋Ⅳ group and SchatzkerⅤ＋Ⅵgroup（P〉0.05）.But after the first 12 months,the Rasmussen Schatzker Ⅲ＋Ⅳ group,HSS scores were signifi-cantly higher in SchatzkerⅤ＋Ⅵgroup（P〈0.05） during the last follow-up.During the last follow-up,the excel-lent and good rate of knee function in the SchatzkerⅢ＋Ⅳgroup was 85.71%,higher than that of SchatzkerⅤ＋Ⅵ（75%） group,but the difference was not significant（P〉0.05）.Conclusion Arc incision via double spatium in-termuscular approach in the treatment of different types of fracture of posterolateral tibial plateau can achieve good results and functional recovery after reduction.The postoperative knee function recovery in Schatzker Ⅲ＋Ⅳ pa-tients is better than in typeⅤ＋Ⅵ.