后内侧联合前外侧入路治疗胫骨外侧平台后外侧劈裂塌陷骨折

TREATMENT OF POSTEROLATERAL TIBIAL PLATEAU COLLAPSED AND SPLITED FRACTURES BY POSTEROMEDIAL AND ANTEROLATERAL APPROACHES

目的探讨后内侧联合前外侧入路治疗胫骨外侧平台后外侧劈裂塌陷骨折的疗效。方法回顾性分析2010年8月-2013年8月收治的19例外伤致胫骨外侧平台后外侧劈裂塌陷骨折患者临床资料。男13例,女6例;年龄25～75岁,平均36.9岁。左侧8例,右侧11例。均为闭合性骨折。骨折根据CT三柱分型标准均为波及后侧柱的劈裂塌陷骨折,按Schatzker分型标准均为Ⅱ型,按国际内固定研究协会/美国骨创伤协会（AO/OTA）分型标准均为41-B3.1.2型。受伤至手术时间7～14 d,平均9 d。采用后内侧入路直视下复位骨折并植入同种异体人工骨,桡骨远端T形钢板行支撑内固定;前外侧入路下取微创内固定系统（less invasive stabilization system,LISS）钢板固定劈裂骨折。结果手术时间50～105 min,平均69.0 min。术后切口均Ⅰ期愈合,无血管、神经损伤及感染等早期并发症发生。患者均获随访,随访时间14～20个月,平均18.2个月。X线片及CT扫描复查均显示胫骨平台高度和关节面恢复良好;骨折均达骨性愈合,愈合时间10～16周,平均12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,获优12例,良5例,可2例,优良率89.5%。结论对于胫骨外侧平台后外侧劈裂塌陷骨折,经后内侧入路能较好显露胫骨后外侧、后内侧平台,允许直视下复位骨折并植骨内固定,经前外侧入路植入LISS钢板,手术创伤小、手术时间短且并发症少。

Objective To explore the effectiveness of posteromedial and anterolateral approaches in the treatment of posterolateral tibial plateau collapsed and splited fractures. Methods Nineteen consecutive patients with posterolateral tibial plateau collapsed and spired fractures were treated between August 2010 and August 2013, and the clinical data were retrospectively analyzed. There were 13 males and 6 females, with an average age of 36.9 years （range, 25-75 years）. All cases had closed fractures, involving 8 left sides and 11 right sides. Fractures involved posterior column according to the three- column classification based on CT scans; according to the Schatzker classification, all fractures were type II; according to the AO/Association for the Study of Internal Fixation classification （AO/OTA）, all fractures were type 41-B3.1.2. The interval between injury and operation was 7-14 days （mean, 9 days）. The reduction of collapsed fractures and implantation of artificial bone allograft were supported by T-shaped distal radius plate via the posteromedial approach. The splited fractures was fuxed by less invasive stabilization system （LISS） plate via the anterolateral approach. Results The mean operation time was 69.0 minutes （range, 50-105 minutes）. All incisions healed by first intention without neurovascular complications or wound infection. All patients were followed up 14-20 months （mean, 18.2 months）. X-ray and CT examinations showed that collapsed tibial plateau and joint surface were completely corrected; bony union was obtained at 12 weeks on average （range, 10-16 weeks）. No secondary collapsed fracture and knee varus or valgus occurred. The results were excellent in 12 cases, good in 5 cases, and fair in 2 cases with an excellent and good rate of 89.5% according to the Rasmussen＇s scoring system for knee function. Conclusion The posteromedial approach combined with anterolateral approach for posterolateral tibial plateau fractures can fully expose the posterolateral aspects of the tibial plateau, and thus collapsed and splited fractures can be treated at the same time, which will lead to less operative time and good outcomes in the treatment of posterolateral tibial plateau collapsed and splited fractures.