内侧入路治疗胫骨平台双柱骨折的疗效分析

Single-incision Approach for the Treatment of the Double Column Fractures of Posteromedial Tibial Plateau

目的探讨用单切口治疗胫骨平台内后侧双柱骨折的手术方法和临床疗效。方法采用患膝关节内侧沿“鹅足”走行方向做纵S型切口，利用单一切口完成内、后侧双柱骨折的复位、固定。结果本组5例患者均获得随访，骨折均愈合。采取的多模式镇痛、超前镇痛，患膝关节可以早期、主动、无痛、充分的屈伸活动，患膝关节屈伸活动度在术后2周内，达到正常或接近正常，达到100°～120°，平均110°。术后对膝关节功能采用HSS评分标准评定，本组获优3例，良2例。结论单切口治疗胫骨平台内后侧双柱骨折，是结合内侧切口和后内侧切口的优点，能够同时完成内后侧两柱的显露、复位和固定，不但暴露骨折块安全、全面，且手术操作方便，还可避免双切口所引发的皮肤坏死，减少感染的发生。获得满意效果。

Objective Discuss the operation method and clinical efficacy of the single-incision approach for the treatment of the double column fractures of posteromedial tibial plateau. Methods We get the reduction and internal fixation of the double column fractures of posteromedial tibial plateau with the S-type single operative incision that along the foot contorts the goose of medial knee. Results The 5 patients were followed up, all fractures consolidated. The knees can get normal or near normal range of motion that locate between 100°- 120°, with the average content of 110° in two weeks after the operation. The results owe to Multimodal analgesia and preemptive analgesia, because they can give early, active, painless and sufficient functional training to knees. The function of knees were assessed according to HSS, there were 3 cases excellent and 2 cases good. Conclusion The single- incision approach for the treatment of the double column fractures of posteromedial tibial plateau combines the advantages of medial and posteromedial incision, it can simultaneously accomplishes the exposure, redction and fixtion to the posteromedial tibial plateau. It not only gets sufficient and safe exposure about the fractures, but also decreases the risk of double incision, such as cutaneous necrosis and infection. We get the satisfied result finally.