扩大内后侧入路治疗胫骨平台内后髁骨折的临床疗效分析

Enlarged Posterior Approach for the Treatment of Posterior Malleolar Fractures of the Tibial Plateau

目的 探讨膝关节扩大内后侧入路对胫骨平台内侧及内后髁骨折的手术显露复位及胫骨后内侧阻挡钢板结合前内侧“竹筏”固定的临床效果。 方法 23例患者均为新鲜闭合性骨折,无神经、血管合并伤。采用膝关节扩大内后侧入路,切开复位后前内侧采用T型3孔排钉固定+后内侧重建板塑形后阻挡固定。通过X线检查评估骨折复位质量及观察骨折愈合时间并进行功能评分。 结果 术后X线检查均提示骨折解剖复位,关节面平整,平台后倾角恢复正常;Rasmussen胫骨平台骨折复位放射学评分为14~18分。切口愈合时间12~14d。患者随访5~38月,骨折愈合时间3~6月。KSS膝关节临床功能恢复评价优18例、良5例,无并发症发生。 结论 胫骨平台内后髁骨折采用膝关节扩大后内侧手术入路,创伤小,手术显露好,能直视下进行解剖复位,后侧阻挡钢板支撑保护,允许患者早期负重和屈膝功能锻炼。

Objective To explore the effectiveness of enlarged posteromedial approaches in the treatment of posteromedial tibial plateau collapsed and split fractures and implantation of "bamboo raft" plate and posteromedial support plate. Methods Twenty- three consecutive patients with posteromedial tibial plateau collapsed and split fractures were treated between June2013 to March2016, and the clinical data were retrospectively analyzed. There were 7 males and16 females (15 with injury on the left side,10 on the right), with an average age of 42 years (range,23 -56 years). Fall injury(10 case)and traffic trauma(7 case) were the main causes of the fracture in this study. All of the cases were closed fractures, and no blood vessel or nerve were injured. X-ray radiography examination and 3-dimensional CT reconstruction of knee joint were carried out preoperatively in order to make clear the size of the fragment, its comminution and the degree of dislocation. MRI was also performed to understand the extent of ligament and meniscus injury. The reduction of collapsed fractures and implantation of artificial bone allograft were supported by medial T-shaped locking plate and posteromedial buttress plate via the enlarged posteromedial approach. The quality of fracture reduction and healing time were evaluated by X-ray radiography examination. And the functional score was evaluated according to Knee Society score (KSS). Result X-ray and CT examinations showed that collapsed tibial plateau and joint surface were completely corrected;bony union was obtained at 4.5 months on average (range, 3-6 months). All patients were followed up10-20 months (mean,15.2 months). The wound healing time was12-14 days. The radiology score of the Rasmussen tibial plateau fracture was14-18 points, with excellent in15 cases and good in 8 cases. KSS knee joint clinical function recovery evaluation standard score, excellent18 cases, good 5 cases. No secondary collapsed fracture and knee varus or valgus occurred. Conclusions Our results confirmed that the enlarged posteromedial incision combined with tibia lateral "bamboo raft" steel plate and posteromedial buttress steel plate fixation in the treatment of tibial plateau fractures involving in posteromedial column can produce good therapeutic effects.