改良后外侧入路2．4mm系统桡骨远端锁定钢板治疗胫骨平台后外侧塌陷骨折

Treatment of posterolateral depression fractures of tibial plateau with improved posterolateral approach and 2. 4 nun distal radius locking plate

目的探讨改良后外侧入路2．4mm系统桡骨远端锁定钢板治疗胫骨平台后外侧塌陷骨折的临床效果。方法回顾性分析2013年11月至2015年12月间手术治疗的11例单纯后外侧胫骨平台塌陷骨折患者资料，男7例，女4例；年龄23—75岁，平均35．9岁；根据CT三柱分型，11例均为后外侧柱单纯塌陷骨折，基于AO／OTA分型为41B-2．2．4型。经后外侧入路显露、复位骨折并植骨，用2．4mm系统桡骨远端锁定钢板内固定；末次随访时使用美国特种外科医院（HSS）膝关节评分评定患膝功能，同时检查Lachman试验，并采用X线片评估关节面及后倾角。结果所有患者术后均无神经症状，切口均一期愈合，术后获6．18个月（平均10．4个月）随访。骨折愈合时间为8～12周，平均9周。术后即刻及6个月外侧胫骨平台后倾角为5°～9°（平均7．70）和5°～10°（平均7．8°）。末次随访时HSS评分为90—97分（平均92．5分）。术后6个月关节屈曲度为120°～140°（平均128°）。所有患者Lachman试验均阴性，未发生钢板及螺钉断裂现象。结论改良后外侧入路2．4mm系统桡骨远端锁定钢板内固定治疗胫骨平台后外侧塌陷骨折安全、牢靠，且可获得较好的疗效。

Objective To report the clinical results of treating posterolateral depression fractures of tibial plateau with improved posterolateral approach and 2. 4 mm distal radius locking plate. Methods In the period from November 2013 to December 2015, 11 posterolateral depression fractures of tibial plateau underwent surgical treatment. They were 7 men and 4 women, aged from 23 to 75 years （average, 35.9 years）. Based on the CT three-column classification, all were simple depression fractures of the posterolateral column; based on the AO/OTA classification, all were type 41B-2.2.4. All the fractures were exposed and reduced via the posterolateral approach. Following bone graft, 2.4 mm distal radius locking plates were used to fix the fractures. The knee function was evaluated at the final follow-up using The Hospital for Special Surgery （HSS） score. Lachman tests were conducted. The articular surfaces and the posterior slope angles were assessed on the X-ray films. Results No nerve symptoms were noted postoperatively. All the incisions got primary healing. The patients obtained follow-ups of 6 to 18 months （average, 10. 4 months）. The fractures united after 8 to 12 weeks （average, 9 weeks）. Anatomical reduction was shown on the postoperative X-ray films. The mean posterior slope angle of the lateral tibial plateau was 7.7° （range, from 5° to 9°） immediately after operation, which was 7.8° （range, from 5° to 10°） 6 months after operation. The mean HSS score was 92.5 （range, from 90 to 97） at the final follow-up. The mean knee flexion was 128° （range, from 120° to 140°） 6 months after operation. All the Lachman tests gave a negative result. No breakage of the implants occurred in this series. Conclusion Internal fixation can be done safely, reliably and effectively with improved posterolateral approach and 2. 4 mm distal radius locking plates in the treatment of posterolateral depression fractures of tibial plateau via a modified posterolateral approach.