膝后内侧入路修复胫骨平台骨折合并胭动脉损伤

目的：探讨膝后内侧入路修复胫骨平台骨折合并胭动脉损伤的技术要领。方法：采用仰卧位膝后内侧入路修复胫骨平台骨折并胭动脉损伤18例，其中胭动脉直接吻合10例、血管桥接8例；胫骨平台骨折均行有限内固定辅以外固定架固定。结果：术后14例小腿全部存活，4例出现部分坏死。骨折愈合9例，延迟愈合9例；骨折愈合时间3-17个月，平均6．9个月。18例均获随访，时间为0．5～2．5a，平均1．1a。其中14例于6个月后恢复行走功能，步态基本正常；4例因小腿前外侧肌群坏死出现足下垂内翻畸形，二期行踝关节融合术后均恢复行走功能，步态基本正常。结论：膝后内侧入路简单、安全、显露好，是修复胫骨平台骨折合并胭动脉损伤的理想入路。

Fracture Repair of Tibial Plateau with Injury of Popliteal Artery through after Knee Medial Approach

Objective：To explore thecharacteristics and main technical points associated with fixation of tibia[ plateau fracture with popliteal artery injury through medial approach. Methods： 18 patients with tibia[ plateau fracture associated with injured poplitea[ artery were treated through medial approach; 10 patients by straight anatomizing popliteal artery and 8 patients by grafting. Tibial plateau fractures were repaired with limit- ed internal fixation and external fixation. Results： 14 cases all survived, 4 cases were partial necrotized, and the average healing time was 6.9 months. Fracture healing time was normal for 9 cases and delayed healing oc- curred for remaining 9 cases. Normal Bone healing time ： 3 - 17 months. All 18 visited for follow up examina- tion, follow up time range ： 0. 5 - 2.5 years, average follow up time was 1.1 years. 14 cases regained the walk- ing function after 6 months with normal gait. 4 cases had varus deformity because of necrosis of anterolateral leg muscle group. 4 cases regained the walking function after the second phase ankle arthrodesis. Conclusions ： Me- dial approach is simple, safe and idea[ for tibial plateau fractures associated with poplitea[ artery injury with good functional restoration.