经后外侧入路治疗胫骨平台后外侧骨折

目的探讨经后外侧入路治疗胫骨平台后外侧骨折的临床疗效。方法手术治疗21例胫骨平台后外侧骨折患者,采用后外侧入路显露胫骨后外髁,对骨折进行支撑钢板内固定,关节面塌陷者采用异体骨或自体髂骨植骨。结果 21例均获随访,时间13~19个月。1例膝关节伸直轻度受限(-5.0°),其余患者无膝关节伸直障碍。膝关节总伸屈度95.0°~135.0°(122.6°±12.8°)。骨折均愈合,愈合时间9~16周。Rasmussen放射学评分:术后即刻13~18(16.2±2.7)分,末次随访时11~18(15.5±3.2)分。后倾角:术后即刻6.0°~9.0°(7.8°±1.5°),末次随访5.5°~10.0°(7.6°±1.8°)。HSS膝关节评分65~98(83.9±8.2)分。结论经后外侧入路治疗胫骨平台后外侧骨折尽管暴露范围较局限,但可直视下进行复位固定位置,具有一定优势,是一种比较理想的入路。

Operative treatment of posterolateral tibial plateau fractures via posterolateral approach

Objective To evaluate the clinical results of treatment for the posterolateral tibial plateau fractures via posterolateral approach. Methods 21 cases with posterolateral tibial plateau fracture were treated with buttress plate fixation via posterolateral approach. Autogenous ilium graft or allograft were used if necessary. Results All cases were followed up for 13-19 months. One patient got knee extension limitation （-5. 0°）. The rest got good extension. The range of motion was 95. 0°-135. 0°（122. 6° ± 12. 8°）. At the final follow-up, bone union was obtained in all ca-ses,the healing time was 9-16 weeks. The mean Rasmussen score was 16. 2 ± 2. 7 （range,13-18） and 15. 5 ± 3. 2 （range,11-18）among immediate and final follow-up postoperation. The PA was 7.8° ±1.5°（range,6° -9°）and 7. 6° ± 1. 8°（range,5. 5°-10°） among immediate and final follow-up. The mean HSS was 83. 9 ± 8. 2 （range,65-98）. Conclusions The operative treatments for the posterolateral tibial plateau fractures via posterolateral approach can provide direct visual positioning and fixation, it can be effectively used to treat posterolateral tibial plateau frac-tures.