后内侧倒L形联合前外侧入路与传统前内外侧入路治疗胫骨平台后柱骨折

The posteromedial inverted L-shaped combined with anterolateral approaches and traditional anteromedial and anterolateral approaches for posterior column fractures of tibial plateau

目的比较后内侧倒L形联合前外侧入路与传统前内外侧入路治疗胫骨平台后柱骨折的疗效。方法 回顾性分析40例累及后柱的胫骨平台骨折患者资料,按治疗方法分为观察组(23例)与对照组(17例),观察组行后内侧倒L形联合前外侧入路,后外和后内侧骨块均采用支撑钢板固定;对照组行传统前内外侧入路,后内侧骨块采用侧方或后方支撑钢板固定,后外侧采用排筏螺钉固定。结果 患者均获得随访,时间18~30个月。两组失血量、术后即刻及术后12个月胫骨平台内翻角(TPA)与胫骨平台后倾角(PA)比较差异均无统计学意义(P>0.05)。观察组手术时间长于对照组(P<0.05),但骨折愈合时间、完全负重时间、Rasmussen放射学评分优良率优于对照组(P<0.05)。结论 后内侧倒L形入路联合前外侧入路可以处理大多数累及后柱的胫骨平台骨折,具有显露清楚、软组织损伤小、后方支撑固定牢靠的优点。

Objective To compare the treatment efficacy of posterior column fractures of tibial plateau via posteromedial inverted L-shaped combined with anterolateral approaches and traditional anteromedial and anterolateral approaches. Methods A retrospective analysis of 40 cases of tibial plateau fracture involving posterior column was performed. They were divided into observation group (23 cases, posteromedial inverted L-shaped and anterolateral approaches) and control group (17 cases, anteromedial and anterolateral approaches)according to the therapeutic method. The posterolateral and posteromedial bone fragments were fixed with supporting plate in observation group,posterior medial bone mass was fixed with lateral or posterior supporting plate, and posterolateral bone mass was fixed with raft screw in control group. Results All cases were followed up for 18~30 months.There were no statistical differences in blood loss volume,tibial plateau angle (TPA) and posterior angle (PA) immediately after operation and 12 months after operation( P >0.05). The operation time of observation group was longer than that of control group( P<0.05 ). But fracture healing time, full load time, Rasmussen radiological score excellent-good rate in observation group were better than control group( P <0.05). Conclusions The posteromedial inverted L-shaped approach combined with anterolateral approaches can deal with most complex tibial plateau fractures involving the posterior column. It has the advantages of clear exposure, less soft tissue damage and reliable posterior support and fixation.