胫骨平台后髁骨折的后侧入路选择

Selection Of Via Knee Posterior Approach For Operative Treatment Of Posterior Tibial Plateau Fracture

目的探讨采用后侧手术入路治疗胫骨平台后髁骨折的疗效。方法 17例胫骨平台后髁骨折患者中,9例行后内侧入路,6例行后外侧入路,2例行后内后外侧联合入路。术后进行临床及影像学检查,术后X线采用Rasmussen放射学评分进行评估,术后12个月时采用美国特种外科医院膝关节评分方法（HSS）对膝关节功能进行评估。结果 17例患者均获随访,随访时间12~24个月,平均13.6个月,患者均获骨性愈合,愈合时间12~18周,平均14.30周。术后Rasmussen放射学评分平均15.80（13~18）分。HSS评分平均86.50（73~96）分。术后3例患者发生切口问题,均经保守治疗痊愈。末次随访无1例发生感染、骨不愈合、复位丢失、内固定松动、膝关节不稳及神经、血管损伤等并发症。结论胫骨平台后外侧髁骨折应用后外侧入路,后内侧髁骨折应用后内侧入路,后内后外侧髁均骨折可以应用后内和后外联合入路,合并神经血管损伤时采用后正中S形入路;直视下进行平台的复位和固定,允许术后早期进行膝关节功能锻炼,疗效满意。

Objective To evaluate the clinical results of operative treatment for the complex posterior tibial plateau fractures via posterior approach. Methods Seventeen cases with complex posterior tibial plateau fracture from April 2010 to April 2014 were reviewed retrospectively. Posterior lateral approach were used in 9 cases,posterior medial approach were used in 6 cases,and Posterior lateral with medial approach were used in 2 cases. During the treatment and follow- up period,the curative effect was evaluated by using Rasmussen＇s radiological grading for radiological outcomes at each follow- up and HSS grading for clinical examination about the knee joint function at the 12 th follow- up. Results All cases were followed up for an average of 13. 6 months（ range,12- 24 months）. The average radiographic bone union times was 14. 3 weeks（ range,12- 18 weeks）. The mean Rasmussen score was 15. 8（ range,13- 18）,and the mean HSS was86. 5（ range,73- 96）. One wound dehiscence and two partial incision necrosis occurred postoperatively,but they were all uneventfully healed after wound management. No complication,including infection,nonunion,reduction lost,fixation loosening,knee joint instability,iatrogenic injuries occurred. Conclusion Posterior lateral approach use for posterior lateral condylar fracture,posterior medial approach use for posterior medial condylar fracture,and Posterior lateral with medial approach use for posterior medial with lateral condylar fracture. Posterior inverted＂S＂shaped approach use for posterior condylar fracture with vascular or（ and） nerve injury. Direct reduction and fixation,early function exercise can be achieved.