经后外侧入路胫骨后外侧平台骨折复位内固定

Posterolateral approach for open reduction and internal fixation of posterolateral tibial plateau fractures

[目的]评价在胫骨后外侧平台骨折中采用后外侧入路钢板内固定治疗的效果。[方法]回顾性分析2018年1月~2019年2月本院开放复位内固定治疗的胫骨后外侧平台骨折88例患者的临床资料。其中,46例采用后外侧入路,42例采用后正中入路。对比两组患者的围手术期、随访和影像学资料。[结果]所有患者均顺利完成手术,均无医源性血管、神经损伤。后外侧组手术时间、术中出血量、住院时间均显著优于后正中组(P<0.05)。随访12个月以上,后外侧组开始下地行走时间、完全负重活动时间均显著早于后正中组(P<0.05)。随时间推移,两组患者VAS评分显著减少,而HSS评分和ROM显著增加(P<0.05)。相应时间点,后外侧组VAS、HSS评分和ROM均显著优于后正中组(P<0.05)。影像方面,后外侧组骨折复位质量和骨折愈合时间均优于后正中组(P<0.05)。[结论]后外侧入路更有利于胫骨后外侧平台骨折开放复位内固定的治疗,具有安全、高效、创伤小的优势。

[Objective]To evaluate the clinical outcomes of the posterolateral approach(PL)for open reduction and internal fixation(ORIF)of posterolateral tibial plateau fractures by comparison with the posterior middle line approach(PML).[Methods]A retrospective study was conducted on 88 patients who underwent ORIF for posterolateral tibial plateau fractures in our hospital from January 2018 to February 2019.Of them,46 had ORIF performed through PL approach,while 42 patients received operation through PML approach.The perioperative,follow-up and radiographic data were compared between the two groups.[Results]All the patients in both groups had surgical procedures finished successfully without iatrogenic injuries to blood vessels and nerves.The PL group proved significantly superior to the PML group regarding to operation time,intraoperative blood loss and hospital stay(P<0.05).The follow-up lasted for more than 12 months.The PL group returned to ambulation and full weight-bearing activity significantly earlier than the PML group(P<0.05).The VAS score significantly decreased,whereas the HSS score and knee ROM significantly increased in both groups over time(P<0.05),which in the PL group proved significantly superior to the PML group(P<0.05).In term of imaging assessment,the PL group also was significantly superior to the PML group in quality of fracture reduction and bony healing time(P<0.05).[Conclusion]The posterolateral approach does facilitate open reduction and internal fixation of posterolateral tibial plateau fractures with benefit of high safety and efficiency,as well as minimizing iatrogenic trauma.