后内侧切口T形钢板治疗胫骨平台后内侧骨折

Surgical treatment of posteromedial tibial plateau fractures through posteromedial approach with T-shaped plate

[目的]探讨后内侧切口T形钢板治疗胫骨平台后内侧骨折的手术技巧及疗效。[方法]2013年6月~2016年11月共收治23例胫骨平台后内侧骨折患者,7例为单纯后内侧骨折,16例为合并后内侧骨折的平台双髁骨折患者。对内侧平台骨折均采用后内侧切口显露,3.5 mm系统或4.5 mm系统T形钢板固定,合并外侧平台骨折的患者另取前外侧切口显露,双钢板固定。术后1年采用美国特种外科医院(HSS)膝关节评分系统评价膝关节功能。[结果]23例患者均获随访,随访时间12~30个月,平均21个月。所有患者骨折均愈合,无内固定松动及断裂发生。术后骨折复位质量Rasmussen放射学评分优8例,良10例,可5例,优良率78%。术后1年膝关节屈曲活动范围100°~130°,HSS评分65~96分,优9例,良10例,中4例,优良率83%。[结论]胫骨后内侧切口结合T形钢板能较好的复位固定胫骨平台后内侧骨折,术后膝关节功能恢复良好。

[Objective] To explore the surgical technique and outcome of the posteromedial tibial plateau fractures treated with T-shaped plate through the posteromedial approach. [Methods] From June 2013 to November 2016, 23 patients with pos- teromedial tibial plateau fractures were treated with T-shaped plate through the posteromedial approach in our hospital. Of them, 7 patients suffered from isolated medial plateau fractures, while the remaining 16 patients had bicondylar tibial plateau fractures involving the posteromedial plateau. The posteromedial plateau fractures were treated by open reduction and internal fixation （ORIF） with a T-shaped plate and screws of 3.5 mm or 4.5 mm in diameter through the posteromedial approach, where- as the accompanied lateral plateau fractures were dealt with another plate through an anterolateral incision. The knee function was evaluated at one year after operation by The Hospital for Special Surgery （HSS） Score. [Results] All the patients were fol- lowed up for a mean of 21 months （range, 12~30 months）. The solid bone healed achieved in all patients without loosening and breakage of the internal fixation in anyone of them. In term of the Rasmussen＇s radiological criteria, fracture reduction was ranked as excellent in 8, good in 10 and fair in 5 patients, associated with the excellent and good results rate of 78% after opera- tion. At 1 year after operation, the affected knee gained the total range of motion from 100° to 130°. The HSS score ranged from 65 to 96 points, corresponding to the grading of excellent in 9, good in 10, and fair in 4 patients, with the excellent and good re- suits rate of 83%. [Conclusion] Posteromedial approach combined with T-shaped plate provides a safe and effective treatment for the posteromedial fractures of tibial plateau, with satisfactory functional recovery.