经改良前外侧腓骨小头上入路复位内固定治疗累及后外侧柱胫骨平台骨折

Application of modified anterolateral supra-fibular-head approach in treatment of tibial plateau fractures involving posterolateral column

目的探讨经改良前外侧腓骨小头上入路复位内固定治疗累及后外侧柱胫骨平台骨折的疗效。方法2016年1月-2018年9月,采用经改良前外侧腓骨小头上入路复位内固定治疗19例累及后外侧柱胫骨平台骨折。男11例,女8例;年龄28~65岁,平均43.2岁。致伤原因:交通事故伤12例,摔伤5例,高处坠落伤2例。根据Schatzker分型标准:Ⅱ型9例,Ⅲ型4例,Ⅴ型4例,Ⅵ型2例。受伤至手术时间为5~13 d,平均8.5 d。合并骨质疏松2例。记录手术时间及术中出血量,观察术后并发症发生情况。术后定期复查膝关节X线片,了解骨折愈合情况。末次随访时,采用Rasmussen放射学评分评价手术复位疗效,采用美国特种外科医院(HSS)评分评价膝关节功能。结果手术时间65~130 min,平均95 min;术中出血量150~350 mL,平均220 mL。术后切口均Ⅰ期愈合,无切口感染、下肢深静脉血栓形成等并发症发生。患者均获随访,随访时间12~20个月,平均15.4个月。X线片复查示骨折均愈合,愈合时间12~20周,平均14.5周;无内固定物松动或断裂等并发症发生。末次随访时,根据Rasmussen放射学评分评价手术复位疗效:优13例、良4例、中1例、差1例。膝关节功能HSS评分获优14例、良3例、中1例、差1例。膝关节活动度达90°~135°,平均113.4°。结论经改良前外侧腓骨小头上入路治疗累及后外侧柱胫骨平台骨折,可以充分显露骨折断端,具有创伤小、安全、复位及固定可靠等优势。

Objective To explore effectiveness of reduction and internal fixation via modified anterolateral supra-fibular-head approach in treatment of tibial plateau fractures involving posterolateral column.Methods Between January 2016 and September 2018,19 patients diagnosed as tibial plateau fractures involving posterolateral column were treated with reduction and internal fixation via modified anterolateral supra-fibular-head approach.There were 11 males and 8 females with an average age of 43.2 years(range,28-65 years).The causes of tibial fracture were traffic accident(12 patients),falling injury(5 patients),and falling from height(2 patients).According to the Schatzker typing,the tibial fractures were rated as typeⅡin 9 cases,typeⅢin 4 cases,typeⅤin 4 cases,and typeⅥin 2 cases.The time from injury to operation was 5-13 days(mean,8.5 days).There were 2 patients with osteoporosis.The operation time,intraoperative blood loss,and postoperative complications were recorded.The knee X-ray film was reviewed regularly to observe the fracture healing.At last follow-up,the fracture reductions were evaluated by Rasmussen radiological score.The knee joint function was evaluated by Hospital for Special Surgery(HSS)score system.Results The average operation time was 95 minutes(range,65-130 minutes).The average intraoperative blood loss was 220 mL(range,150-350 mL).All incisions healed by first intention.No complications such as infection or deep venous thrombosis occurred.All patients were followed up 12-20 months(mean,15.4 months).X-ray films showed that the fractures healed with the healing time of 12-20 weeks(mean,14.5 weeks).No complications such as loosening or breakage of internal fixation occurred.At last follow-up,according to the Rasmussen radiological score,the fracture reductions were evaluated as excellent in 13 cases,good in 4 cases,fair in 1 case,and poor in 1 case.HSS scores of knee joint function were excellent in 14 cases,good in 3 cases,fair in 1 case,and poor in 1 case.The knee joint range of motion was 90°-135°,with an average of 113.4°.Conclusion Application of modified anterolateral supra-fibular-head approach in reduction and internal fixation for tibial plateau fractures involving posterolateral column has the advantages of full exposure,less trauma,safety,and reliable reduction and fixation.