经后外侧入路治疗胫骨平台后外侧骨折的解剖学研究及应用

目的为经膝关节后外侧入路治疗胫骨平台后外侧骨折提供解剖学基础。方法 (1)福尔马林浸泡的防腐成人下肢标本20例,解剖观察并测量与膝关节后外侧入路相关的主1要血管、神经的走行特点,膝关节后外侧主要肌肉、韧带的分布。(2)新鲜冷藏下肢标本4例,按照设计的入路进行模拟手术,评估该入路的可行性。(3)在解剖学研究的基础上,临床应用12例,观察该入路的临床效果。结果膝关节后外侧入路的手术切口全长均不经过腓总神经主干;深层经腓肠肌外侧头外侧和比目鱼肌肌间隙分离,保护了内侧的血管神经束;胫前血管在腓骨头下方(4.15±0.36)cm处自腘动脉发出,影响了远端的显露,但足够复位固定简单的后外侧骨折。临床应用12例,均取得了满意的疗效。结论经膝关节后外侧入路治疗简单的胫骨平台单纯后外侧骨折具有安全,损伤小,暴露充分,临床效果良好等优点,有一定的推广价值。

Treatment of isolated posterolateral fracture of the tibial plateau via the posterolateral approach: anatomy and clinical implication

Objective　To provide anatomic basis for treating the isolated posterolateral fractures of the tibial plateau by posterolateral approach.　Methods　(1) The main vessels, nerves, muscles and ligaments relative to the posterolateral approach were observed and measured on 20 lower limbs of adult cadavers. (2) To make sure the practicality of the posterolateral approach, surgical simulations were performed on another 4 lower limbs of fresh adult cadavers. (3) The approach was clinically applied on 12 cases. The clinical characteristics and the treatment outcome were also analyzed.　Results　The operative incision of this approach can avoid to reach the common peroneal nerve trunk. The vascular nerve bundles were protected when the deep dissections were carried on in the intermuscular septum between the lateral side of lateral gastrocnemius muscle and the soleus muscle. The distal dissection should be restricted no more than (4.15±0.36) cm below the fibular head level, as the anterior tibial vessel passed through the interosseous membrane, and the space is enough for the reduction and fixation. Satisfied results were obtained in all 12 cases adopting this approach.　Conclusions　The posterolateral approach is an ideal way for the treatment of isolated posterolateral fractures of the tibial plateau. The advantages of this approach are as follows: the exposure is good and safe, the injury is limited and the clinical results are excellent, and it's with certain value for popularization.