胫骨平台后外侧骨折的改良后外侧和改良前外侧入路比较

Comparison of modified posterolateral and modified anterolateral approaches for posterolateral tibial plateau fractures

目的探讨改良后外侧和改良前外侧入路在治疗胫骨平台后外侧骨折(posterolateral tibial plateau fracture,PTPF)的效果。方法选取我院在2021年1月至2022年1月收治的68例PTPF患者,采用改良后外侧入路(改良后外侧组,n=34)和改良前外侧入路(改良前外侧组,n=34)治疗。比较两组患者关节面塌陷程度、影像学参数、伸屈活动度、美国特种外科医院(Hospital for Special Surgery,HSS)评分和Lysholm评分。结果改良后外侧组患者手术时间大于改良前外侧组患者(P<0.05);术中出血、切口长度和骨折愈合时间低于改良前外侧组患者(P<0.05)。改良后外侧组患者术后6个月、12个月的关节面塌陷高度低于改良前外侧组(P<0.05)。末次随访,改良后外侧组患者的伸和屈活动度以及HSS评分和Lysholm评分高于改良前外侧组患者(P<0.05)。结论改良后外侧入路和改良前外侧入路均能有效治疗PTPF。尽管改良后外侧入路具有更好的治疗效果,但对术者手术经验和专业素质要求较高。

Objective To investigate the efficacy of modified posterolateral and modified anterolateral approaches in the treatment of posterolateral tibial plateau fracture (PTPF).Methods Sixty-eight patients with PTPF admitted to our hospital between January 2021 and January 2022 were selected and treated with modified posterior lateral approach (modified posterior lateral group,n=34) and modified anterior lateral approach (modified anterior lateral group,n=34).The degree of articular surface collapse,imaging parameters,extension and flexion,HSS score and Lysholm score were compared between the two groups.Results The operation time of patients in the modified posterolateral group was greater than that of patients in the modified anterolateral group (P < 0.05);intraoperative bleeding,incision length,and fracture healing time were lower than those of patients in the modified anterolateral group (P < 0.05).The height of articular surface collapse at 6 and 12 months after surgery was lower in patients in the modified posterolateral group than in the modified anterolateral group (P < 0.05).At the final follow-up,extension,flexion,HSS score and Lysholm score of patients in the modified posterolateral group were higher than those of the pre-modified posterolateral group (P < 0.05).Conclusions Both the modified posterolateral approach and the modified anterolateral approach are effective in treating posterolateral tibial plateau fractures.Although the modified posterolateral approach has better treatment results,it requires more surgical experience.