后外侧倒L形入路3.5mm T形支撑钢板内固定治疗单纯后外侧胫骨平台骨折疗效观察

Clinical observation of 3.5 mm T support plate fixation for simple posterolateral tibial plateau fracture by posterolateral inverted L-shaped approach

目的总结后外侧倒L形入路3.5 mm T形支撑钢板治疗单纯后外侧胫骨平台骨折的临床疗效。方法 2011年3月—2016年1月,采用后外侧倒L形入路3.5 mm T形支撑钢板内固定治疗单纯后外侧胫骨平台骨折13例。男6例,女7例;年龄28~52岁,平均43岁。左侧5例,右侧8例;致伤原因:交通事故伤6例,摔伤3例,高处坠落伤4例。术前行X线片、CT三维重建和MRI检查,均为单纯后外侧胫骨平台骨折;Schatzker分型:Ⅱ型4例,Ⅲ型9例。受伤至手术时间5~9 d,平均7 d。结果术后1例患者切口皮肤坏死,给予清创植皮后创面愈合;余均Ⅰ期愈合。13例患者均获随访,随访时间10~16个月,平均13个月。所有患者术后3个月X线片示骨折线均模糊,术后12个月骨折线均消失。无切口感染、重要血管神经损伤、内固定物松动或断裂以及关节面再次移位塌陷等并发症发生。末次随访时按改良美国特种外科医院(HSS)膝关节功能评分评价膝关节功能,获89~97分,平均94分;均达优。结论后外侧倒L形入路3.5 mm T形支撑钢板内固定可作为治疗单纯后外侧胫骨平台骨折的首选手术方式之一。

Objective To summarize the effectiveness of 3.5 mm T support plate fixation for simple postero- lateral tibial plateau fractures by posterolateral inverted L-shaped approach. Methods Between March 2011 and lanuary 2016, 13 patients with simple posterolateral tibial plateau fracture were treated with 3.5 mm T support plate fixation by posterolateral inverted L-shaped approach. Of 13 cases, 6 were male and 7 were female, aged 28 to 52 years （mean, 43 years）. The left side was involved in 5 cases and the right side in 8 cases. The causes of injury were traffic accidents in 6 cases, fails in 3 cases, and falling from height in 4 cases. All of patients had fresh closed fracture by X-ray, CT three dimensional reconstruction, and MRI. According to Schatzker classification, 4 cases were rated as type II and 9 cases as type III. The time between injury and operation was 5-9 days （mean, 7 days）. Results One case had incision skin necrosis, which was cured after debridement and skin grafting; and primary healing was obtained in the other cases. The patients were followed up 10-16 months （mean, 13 months）. The X-ray film showed that the fracture line was blurred at 3 months after operation, and disappeared at 12 months after operation. There was no complications of wound infection, major neurovascular in）ury, loosening or breakage of internal fixation, and dislocation of joint surface. The Hospital for Special Surgery （HSS） knee function score was 94 （range, 89-97） at last follow-up; all were excellent. Conclusion The 3.5 mm T support plate fixation by posterolateral inverted L-shaped approach is one of preferred surgical method for the treatment of simple posterolateral tibial plateau fractures.