胫骨平台外侧髁ABC骨折分型及治疗策略

Discussion on the classification and treatment strategies of the lateral condylar tibial plateau fractures

目的探讨胫骨平台外侧髁骨折的新分型-ABc分型，并评价其临床应用效果。方法收集2013年3月至2015年6月收治的83例胫骨平台外侧髁骨折患者的资料，其中男49例，女34例；年龄25-76岁，平均49．1岁。所有患者采用胫骨平台外侧髁ABC骨折分型，其中B型骨折51例，c型骨折6例，AB型骨折9例，BC型骨折13例，ABC型骨折4例，根据胫骨平台外侧髁骨折ABC分型选择手术入路及内固定方式。B型、AB型骨折选用前外侧入路，采用前外侧平台钢板固定，其中AB型骨折辅助边缘钢板固定。c型骨折选用Carlson切口入路，采用“T”型支撑钢板内固定，BC型、ABC型骨折采用Frosch外侧延展入路。术后随访通过X线片及CT扫描评估骨折愈合、复位丢失情况和内固定位置，采用Rasmussen放射学标准评估胫骨平台骨折复位情况，采用美国特种外科医院（Hospital for Special Surgery，HSS）评分评估术后12个月膝关节功能。结果83例患者均顺利完成手术，手术时间为90-160min，平均121min。69例获得随访，随访时间12-24个月，平均14．6个月，随访率为83．1％（69／83）。各分型骨折愈合时间无明显差别，骨折临床愈合时间12-16周，平均13．5周。术后12个月Rasmussen放射学评分为13～18分，平均16．9分；优54例，良15例。术后12个月HSS膝关节评分82-98分，平均94．1分，均评价为优。结论基于CT扫描的胫骨平台外侧髁骨折ABC分型临床应用简单、方便和实用，对胫骨平台外侧髁骨折的手术入路和内固定方式选择等有较好的指导作用。

Objective To discuss on the ABC classification of the lateral condylar tibia1 plateau fractures, and to evalu- ate its clinical application. Methods From March 2013 to June 2015, 87 patients with lateral condylar tibial plateau fracture were treated in our hospital, including 49 males and 34 females with the mean age of 49.1 years （range, 25-76）. A new classifica- tion system of the lateral condylar tibial plateau fracture, ABC Classification, was used for all the 83 patients. There were 51 pa- tients for type B, 6 for type C, 9 for type AB, 13 for type BC, 4 for type ABC. Surgery approach and fixation method depended on the type of fracture. Anterior-lateral approach and anterolateral locking plate fixation were used to treat type B and AB, and addi- tional marginal plate were used in type AB. Carlson approach and T-buttress plate fixation were used to treat type C. Frosch ap- proach was used to treat type BC and ABC. The radiographic and clinical results were evaluated by using Rasmussen＇s radiologi- cal and HSS grading at 12 months postoperatively respectively. Results 83 patients underwent surgeries successfully, with aver- age time of 121 rains （range, 90-160 rains）. With a follow-up rate of 83.1%, 69 patients were followed up for 12-24 months, the mean follow-up time was 14.6 months. There was no significant difference in fracture healing time of different types. The average time for fracture union were 13.5 weeks （range, 12-16 weeks）. The mean score of the Rasmussen＇s radiological grading was 16.9 （range, 13-18）. All the results according to HSS grading are excellent and the mean score of the HSS grading was 94.1 （from 82- 98）. Conclusion CT-based ABC Classification is worthy of popularization and application in clinics, and it is more reliable and instructive in the treatment of lateral condylar tibia] plateau fractures.