腓骨头上方入路联合自制解剖钢板在胫骨平台后外侧髁骨折中的应用

目的探讨腓骨头上方入路联合自制胫骨平台后外侧髁解剖钢板治疗胫骨平台后外侧髁骨折的临床疗效及优势。方法自2016年3月至2018年8月,筛选胫骨平台后外侧髁骨折12例,男8例,女4例;年龄23~66岁,平均(48.5±11.7)岁。按胫骨外侧平台三维CT分区概念细化:累及Ⅰ区的12例,累及I区+Ⅱ区的11例,累及Ⅰ区+Ⅱ区+Ⅲ区的5例。均采用腓骨头上方入路联合自制解剖钢板进行显露复位固定,术后定期复查,指导膝关节功能锻炼,观察术后并发症发生情况。末次随访根据Rasmussen放射评分标准评估骨折复位内固定情况,临床疗效采用纽约特种外科医院(hospitalfor special surgery,HSS)膝关节功能评分标准进行评价。结果手术时间46~65 min,平均(51.5±5.9)min;伤口均一期愈合,未发生感染、皮肤坏死、骨髓炎及神经损伤等并发症。随访时间10~31个月,平均(13.5±6.2)个月。随访期间未发生内固定松动、断裂或移位,未出现膝关节不稳、关节面再塌陷、膝关节内外翻畸形等。按Rasmussen放射评分标准,优9例,良2例,可1例,优良率为91.7%。骨折于术后9~12周达到临床愈合,平均(10.8±1.2)周。8例于术后11~18个月顺利取出内固定,平均(13.5±2.2)个月。末次随访根据HSS评分系统评定膝关节功能,优10例,良1例,可1例,优良率91.7%。结论腓骨头上方入路显露胫骨平台后外侧髁具有简单安全、创伤小、无血管神经损伤风险等优势,胫骨平台后外侧髁解剖钢板可以对后外侧髁骨折块起到直接有效的支撑作用,两者联合使用在胫骨平台后外侧髁骨折治疗中具有明显优势,是一种值得借鉴推广的方法。

Clinical Application of Self-made Anatomic Plate for Posterolateral Tibial Plateau Fracture with the Supra-fibular-head Approach

Objective To evaluate the clinical effect and identify the advantages for the treatment of posterolateral tibial plateau fracture by using self-made anatomic plate for posterolateral condyle of tibial plateau with the supra-fibular-head approach.Methods 12 patients with posterolateral tibial plateau fracture were selected and treated from March 2016 to August 2018.They aged from 23 to 66 years with an average of(48.5±11.7)years.According to the 3D CT segmentation for lateral tibial plateau:12 cases had fractureinⅠarea;11 cases in bothⅠ+Ⅱareas;5 cases inⅠ+Ⅱ+Ⅲareas.Self-made anatomic plate for posterolateral tibial plateau with the supra-fibular-head approach was applied to all these patients.After the operation,these patients hadperiodically follow-up,guidance for knee joint functional exercise and observation for postoperative complications.The fracture reduction was evaluated according to the Rasmussen score of the knee joint.The knee joint function was evaluated by thescore of the hospital for special surgery(HSS).Results The operation took 46~65 mins,average(51.5±5.9)mins.All of wounds healed by first intention without complications like infection,skin necrosis,osteomyelitis or nerves injuries etc.Follow-up period was 10~31 months,average(13.5±6.2)months.During this time period,there was no internal fixation failure,fracture or displacement.No knee joint instability or articular step-off,no malformation of knock knee or bow leg etcwere founded.Accordingto Rasmussen radiographic evaluation,clinical outcomes were excellentin 9 cases,goodin 2 cases,fairin 1 cases.It took 9~12 weeks for clinical fracture healing after the operation,with an average(10.8±1.2)weeks.Internal fixation was successfully taken out for 8 studies in 11~18 months after the operation,with an average(13.5±2.2)months.The mean HSS(the Hospital for Special Surgery)score of all patients were excellent in 10 cases,good in 1 case and fair in 1 case with the excellent and good rate was 91.7%.Conclusion These results reveal that the supra-fibular-head approach is simple and safe,with minimal trauma and without the risk of blood vessels or nerves injuries.The anatomic plate for posterolateral tibial plateau can have a direct and efficient support to the fracture fragments.The combination use of both has an obvious advantage to treat posterolateral tibial plateau fractures,which is worth learning and promoting.