改良前外侧入路胫骨近端锁定加压钢板固定治疗胫骨平台后外侧骨折

目的 探讨改良前外侧入路胫骨近端锁定加压钢板固定治疗胫骨平台后外侧骨折的近期临床疗效.方法 2010年6月至2012年3月采用改良前外侧入路胫骨近端锁定加压钢板固定治疗胫骨平台后外侧骨折并获得随访的患者19例,男11例,女8例；年龄26～55岁,平均38.3岁.均为新鲜闭合性骨折.车祸伤10例,高处坠落伤7例,跌伤2例.合并胫骨平台前十字韧带止点撕脱骨折2例.受伤至手术时间3～15 d,平均7.5 d.手术均采用膝关节前外侧“S”形皮肤切口,较常规切口偏向后上,用胫骨近端锁定加压钢板固定,术后早期行膝关节功能锻炼.术后复查X线片和CT三维重建,3个月内每月复查X线片,采用Rasmussen膝关节功能评分标准评价膝关节功能.结果 手术时间80～120 min,平均95 rin;术中出血量100～400 ml,平均180 ml.随访时间12～24个月,平均16.2个月.全部获得骨折愈合,愈合时间8～14周.随访期间无内固定松动、断裂、骨不愈合,无膝关节内、外翻畸形和骨折再移位,无膝关节不稳.18例患者达到解剖复位；1例后外侧粉碎骨折脱位患者术后CT提示存在2 mm关节面台阶,患者行走2 km后出现膝关节轻度疼痛,膝关节伸屈0°-105°.1例患者膝关节伸屈5°-90°.Rasmussen膝关节功能评定13～30分,平均(22.9±4.9)分,优10例、良7例、可2例,优良率89.5％.结论 改良前外侧入路胫骨近端锁定加压钢板固定治疗胫骨平台后外侧骨折操作简单安全,固定可靠,并发症少.

Locking compression plate fixation through a modified anterolateral approach for posterolateral tibial plateau fractures

Objective To investigate the clinical efficacy of locking compression plate fixation through a modified anterolateral approach for posterolateral tibial plateau fractures. Methods From June 2010 to March 2012, 19 patients with posterolateral tibial plateau fractures underwent locking compression plate fixation through a modified anterolateral approach in our hospital. There were 11 males and 8 females, aged from 26 to 55 years (average, 38.3 years). The injury causes included traffic accident in 10 cases, fall from height injury in 7 cases and falling injury in 2 cases. Two patients had avulsion fracture of the anterior cruciate ligament. The modified lateral S-shaped incision was adopted for all patients. All the patients underwent early and suitable rehabilitation after operation. The radiographic and clinical results were evaluated by using X-rays and the Rasmussen score, respectively. Results The average operative time was 95 minutes (range, 80 to 120 minutes), and the average intraoperative blood loss was 180 ml (range, 100 to 400 ml). All the patients were followed up for 12 to 24 months (average, 16.2 months). Bone union was obtained in all patients, and the bony union time ranged from 8 to 14 weeks. There was no implant loosening/breakage, bone nonunion, genu valgum, genu varum, redisplacement of fracture, and knee instability. Anatomic reduction was obtained in 18 patients. For one patient with posterolateral comminuted dislocation fracture, CT scan showed a step-off of 2 mm in joint surface after operation, and at final follow-up, the patient suffered from mild pain and the range of motion of the knee joint was 0 to 105 degree. The range of motion of the knee joint was 5 to 90 degree in one patient. The Rasmussen score ranged from 13 to 30 (average, 22.9±4.9); the results were excellent in 10 cases, good in 7 cases and fair in 2 cases, and the excellent and good rate was 89.5%. Conclusion Locking compression plate fixation through a modified anterolateral approach is an effective method for posterolateral tibial plateau fractures, which has several advantages, such as simple and safe operation, stable fixation and less complications.