膝关节后内、外侧倒“L”形入路治疗胫骨平台后柱骨折的解剖学比较

Anatomical comparison between ppoosstteerriioorr medial and lateral inverted L-shapedapproach for the treatment of tibial ppllaatteeaauu fracture involving posterior column

背景:胫骨平台骨折时,如膝关节呈屈曲位受到股骨髁的撞击,易导致胫骨平台后柱发生骨折。有人提出后侧入路可使骨折更好地暴露。本文对两种胫骨平台后柱骨折后侧入路进行解剖学对比。目的:通过对新鲜尸体膝关节后侧进行解剖,比较在胫骨平台后柱骨折中膝关节后内侧和后外侧倒"L"形入路的解剖情况。方法:选取新鲜成人尸体标本6例,男4例,女2例,由同一名医师对其左右膝关节后侧分别行内侧和外侧倒"L"切口,进行解剖,并对解剖过程中不同窗口进行测量、拍照。结果:右膝外侧窗暴露高度明显大于左膝([7.86±1.31)cm vs(4.35±1.79)cm,P<0.05],而两膝外侧窗暴露的宽度无显著统计学差异(P>0.05)。两膝中间窗暴露高度和宽度均无显著统计学差异,可最大范围暴露后侧平台(P>0.05)。内侧窗高度和宽度也无明显区别(P>0.05)。结论:膝关节后内、外侧治疗胫骨平台后柱骨折,可以有效暴露骨折端,并且外侧倒"L"形入路对外侧窗可更好地暴露,便于复位和内固定。

Background： The posterior column of tibial plateau is easily injured and became fractured under the impact of the femoral condyle with the knee flexion. Some scholars proposed posterior approach which can make the fracture better exposed. In this article, we make an anatomical comparison between two approaches of the treatment for tibial plateau fracture involving the posterior column.Objective： To dissect the knee of fresh Chinese cadavers and to compare anatomical differences between posterior medial and posterior lateral inverted L-shaped approach for the treatment of tibial plateau fracture involving the posterior column.Methods： Posterior medial and posterior lateral inverted L-shaped incisions were applied on the left and right knees, respectively, of 6 fresh adult cadavers by the same doctor. Photos were taken and metrical data were recorded for the different windows during the procedure of anatomy.Results： The height of the lateral window in the right knee was significantly larger than that in the left one（[7.86±1.31] vs[4.35±1.79], P〉0.05）, no significant difference was found in the width of the lateral window between the right and the left knee（P〈0.05）. There were no significant differences in the height or width of the middle window between the right and the left knee（P〉0.05）. Neither was the height or width of the medial window（P〉0.05）.Conclusions： The fracture can be exposed effectively by both posterior medial and posterior lateral inverted L- shaped approach for the treatment of tibial plateau fracture involving the posterior column. Besides, lateral window can be better exposed for reduction and internal fixation by lateral inverted L-shaped approach.