经后外侧反弧形切口双肌间隙入路治疗后外侧胫骨平台塌陷骨折

MODIFIED POSTEROLATERAL COUNTER-CURVED INCISION WITH DOUBLE INTERMUSCULAR APPROACH IN TREATING POSTEROLATERAL TIBIAL PLATEAU FRACTURES

目的探讨经后外侧反弧形切口双肌间隙入路治疗后外侧胫骨平台塌陷骨折的安全性及疗效。方法2012年9月-2014年10月,收治32例后外侧胫骨平台塌陷骨折患者。男22例,女10例;年龄19~55岁,平均40.5岁。致伤原因:交通事故伤17例,高处坠落伤9例,摔伤6例。均为新鲜闭合性骨折;受伤至入院时间为3 h^5 d,平均2 d。根据Schatzker胫骨平台骨折分型标准:Ⅱ型20例,Ⅲ型12例。采用经后外侧反弧形切口双肌间隙入路,在腘肌和比目鱼肌间隙以及胫前肌两个间隙分别显露胫骨后外侧髁及前外侧髁,直视下复位骨折并钢板内固定。结果术后患者切口均Ⅰ期愈合,无重要神经血管损伤发生。术后即刻X线片检查示,根据De Coster等分级系统,胫骨平台关节面复位达优21例,可11例。患者均获随访,随访时间18~30个月,平均20.5个月。X线片复查示,骨折均愈合,愈合时间10~16周,平均12.3周;随访期间无内固定物失效、断裂,无明显胫骨平台关节面复位丢失。术后18个月,膝关节活动度为2~135°,平均120°;美国特种外科医院(HSS)评分为83~96分,平均90.05分。结论经后外侧反弧形切口双肌间隙入路可以充分显露后外侧塌陷胫骨平台,并兼顾显露胫骨前外侧平台骨折,直视下骨折复位良好,经支撑钢板固定外侧胫骨平台,可获得满意生物力学稳定。

Objective To evaluate the effectiveness of the modified posterolateral counter-curved incision with double intermuscular approach for the treatment of posterolateral tibial plateau fractures. Methods A retrospective analysis was made on the clinical data of 32 patients with posterolateral tibial plateau fractures between September 2012 and October 2014. There were 22 males and 10 females, aged 19 to 55 years（mean, 40.5 years）. The causes of injury included traffic accident in 17 cases, falling from height in 9 cases, and falling in 6 cases. They had fresh closed fracture; injury to hospitalization time was 3 hours to 5 days（mean, 2 days）. According to Schatzker tibial plateau fracture classification criteria, 20 cases were rated as type II, and 12 cases as type III. All patients underwent a modified posterolateral counter-curved incision with double intermuscular approach to expose tibial posterolateral condyle and anterolateral condyle. After a good visual control of fracture reduction, the anterolateral and posterolateral fractures were fixed with two-dimensional buttress plate respectively. Results The incisions healed at stage I, with no major neurovascular injury. According to radiological assessment of the De Coster score, the results were excellent in 21 cases, and fair in 11 cases. All of the 32 patients were followed up 18 to 30 months（mean, 20.5 months）. The X-ray films showed that all patients obtained good fracture union, and the mean time of fracture union was 12.3 weeks（range, 10-16 weeks）. No fixation failure or no obvious loss of articular surface reduction was observed during follow-up. The range of motion of the affected knees was 2-135°（mean, 120°）. The mean American Hospital for Special Surgery（HSS） score was 90.05（range, 83-96） at 18 months after operation. Conclusion The modified posterolateral counter-curved incision with double intermuscular approach could fully expose posterolateral tibia plateau, and good fracture reduction and reliable fixation can be obtained under direct vision.