扩展的前外侧入路治疗胫骨平台后外侧骨折

Treatment of posterolateral tibial plateau fractures through an extended anterolateral approach

目的：探讨扩展的前外侧入路治疗胫骨平台后外侧骨折的方法和临床疗效。方法：2011年1月至2013年12月,采用扩展的前外侧入路治疗胫骨平台后外侧骨折15例,男9例,女6例;年龄23~70岁,平均（38.4±7.7）岁。左膝7例,右膝8例。致伤原因：车祸伤6例,高处坠落伤7例,平地跌倒伤2例。受伤至手术时间2~14 d,平均5.6 d。结果：所有患者获随访,时间12~30个月,平均19.7个月。术后行膝关节正侧位X线片和CT扫描示14例解剖复位,1例有3 mm的台阶。骨折愈合时间8~14周,平均9.6周。无伤口并发症、骨不愈合、钢板松动或断裂、膝关节外翻畸形和骨折再移位,无腓总神经和血管损伤。在最终的随访时,膝关节伸直（2.1±2.1）°和屈曲（120.6±18.9）°。膝关节Rasmussen功能总评分25.0±2.8,优10例,良4例,可1例。结论：扩展的前外侧入路可充分显露胫骨平台后外侧骨折块,有利于复位,与传统的前外侧入路相比可更安全有效地偏后放置外侧支撑钢板。

Objective：To study the methods and therapeutic effects of posterolateral tibial plateau fractures with an extended anterolateral approach. Methods：From January 2011 to December 2013,15 patients with posterolateral tibial plateau fractures were treated by extended anterolateral approach,including 9 males and 6 females,with an average age of（38.4±7.7） years old ranging from 23 to 70 years old. Seven patients were on the left knees and 8 patients were on the right knees. The injury causes included traffic accidents in 6 cases,falling from height in 7 cases,and falling down when walking in 2 cases. The time from injury to operation was 2 to 14 days（means 5.6 days）. Results：All patients were followed up with an average of 19.7 months ranging from 12 to 30 months. All patients were followed with anteroposterior and lateral X ray and CT films,which showed anatomic reduction or near anatomic reduction. The follow up CT scan showed an anatomic reduction in 14 patients and step and gap measurement of 3 mm in 1 case. The average radiographic bony union time was 9.6 weeks（ranged from 8 to 14 weeks）. There were no wound complications,nonunion,plate loosening or breakage,valgus knee deformity,or fracture redisplacement. No patients sustained neural or vascular injuries,with knee extension of（2.1±2.1）° and knee flexion of（120.6±18.9）° at the final follow up.The total Rasmussen score averaged（25.0 ±2.8） points,the result was excellent in 10 cases,good in 4 cases,fair in 1 case.Conclusion：The extended anterolateral approach has the advantage of allowing visualization of the posterolateral tibial plateau fragments,therefore facilitating its reduction. The approach also ensures safe and adequate posterior placement of a lateral buttress plate because the plate can be placed more posteriorly than can occur through an anterolateral approach.