改良后外侧切口治疗后外侧胫骨平台骨折效果分析

Clinical outcome of modified posterolateral approaches for the treatment of posterolateral tibial plateau fractures

目的：探讨改良后外侧入路手术治疗胫骨平台后外侧骨折的效果。方法我院2012年1月至2015年1月收治13例胫骨平台后外侧骨折患者，均给予改良后外侧入路治疗，根据美国特种外科医院（ HSS）膝关节评分系统评定术后膝关节功能，并观察术后并发症发生情况。结果13例患者均获得随访，平均随访时间14．4个月，骨折全部愈合。膝关节HSS评分术后3个月为（71．6±1．5）分，术后6个月为（76．4±1．6）分，术后12个月为（83．2±1．1）分，不同时间比较差异无统计学意义（P＝0．154）。胫骨平台角术后即刻为（83．7±1．7）°，术后3个月为（84．3±1．5）°，术后6个月为（85．1±1．4）°，术后12个月为（85．4±1．5）°，不同时间比较差异无统计学意义（P＝0．223）。内侧和外侧后倾角术后即刻为（7．7±1．5）°，术后3个月为（7．7±1．4）°，术后6个月为（7．7±1．3）°，术后12个月为（7．6±1．8）°，不同时间比较差异无统计学意义（ P＝0．191）。13例患者无切口感染和内固定失败，无畸形愈合。结论对于胫骨平台后外侧骨折，改良后外侧入路能获得较好的骨折显露，能够直视下复位和放置钢板并可靠固定，术后功能恢复良好。

Objective To observe the clinical outcome of modified posterolateral approaches for the treatment of posterolateral tibial plateau fractures. Methods From January 2012 to January 2015,13 patients with posterolateral tibial plateau fractures were identified in the Second Hospital of Changzhou Affiliated to Nan-jing Medical University. All the posterolateral fractures were fixated with a plate. The knee function was evaluated at the last follow-up by the Hospital for Special Surgery（ HSS） Score,and the occurrence of postoperative compli-cations were observed. Results Thirteen patients were followed up for an average of 14. 4 months,all patients obtained bony union. There were no significant differences regarding the mean HSS score among 3 months, 6 months and 1 year post-operation（（71. 6±1. 5） points, （76. 4±1. 6） points, （83. 2±1. 1） points;P=0. 154） . There were no significant differences regarding the tibial plateau angle and posterior slope angle on radiograph-ies of inside and outsideamong immediate,6 and 12 months postoperation（（83. 7±1. 7）°,（84. 3±1. 5）°,（85. 1 ±1. 4）°,（85. 4±1. 5）°;（7. 7±1. 5）°,（7. 7±1. 4）°,（7. 7±1. 3）°,（7. 6±1. 8）°;P=0. 223,0. 191）. No com-plications associated with the approach were observed and there was no infection,no malunion or fixation failure either. Conclusion In the treatment of posterolateral tibial plateau fractures,the modified posterolateral approa-ches can result in excellent fracture reduction under direct visualization and allow for posterior buttress plating.