后内侧联合前外侧入路治疗累及后内髁的胫骨平台双髁骨折21例分析

目的 探讨后内侧联合前外侧手术入路治疗后内髁受累及的胫骨平台双髁骨折的临床疗效.方法 收集21 例累及后内髁的SchatzkerⅤ型、Ⅵ型胫骨平台骨折患者,其中累及双后髁的5 例,不累及外后髁的16 例,手术均采用后内侧联合前外侧入路,手术中对于累及后外侧髁的患者,关节镜下监视行前外侧开窗,通过骨隧道复位、植骨支撑、固定.结果 本组21 例患者获得平均(12.24±2.48)个月的随访,骨折均获骨性愈合,愈合时间4～9 月,无切口皮肤坏死、关节不稳及内外翻畸形愈合等发生.膝关节功能:优13 例,良5 例,可2 例,差1 例.骨折复位满意度:优15 例,良4 例,可1 例,差1 例.结论 对于累及后内侧髁的胫骨平台双髁骨折,采用后内侧联合前外侧入路能有效取得骨折的复位、牢靠固定,并可早期进行功能训练,远期疗效满意.

Treatment of bicondylar tibial plateau fractures involved posteromedial condyle through combined posteromedial and anterolateral approach

Objective To investigate the clinical results of bicondylar tibial plateau fractures involved posteromedial condyle through combined posteromedial and anterolateral approach. Methods From May 2005 to December 2009, 21 cases of SchatzkerV/VI tibial plateau fractures involved posteromedial condyle （5 bilateral and 16 non-posterolateral）were treated with combined posteromedial and anterolateral approach. Anterolateral fenestration, anatomical reduction and internal fixation were performed in involved posterolateral condyle. Results All patients were followed up for an average of 12.24 months. All wounds achieved healing after 4 to 9 months without complications such as flap necrosis, redisplacement or malunion. According to Rasmussen＇s functional grading system for knee joint function, 13 patients got excellent results, 5 good, 2 fair, and 1 poor. According to Rasmussen＇s anatomical grading system for fracture reduction, 15 patients got excellent results, 4 good, 1 fair, and 1 poor. Conclusions Combined posteromedial and anterolateral approach is effective and result in reduction and rigid fixation in treating the bicondylar tibial plateau fractures involved posteromedial condyle.