胫骨平台后外侧柱骨折扩大外侧入路内固定增强力学稳定性及膝关节功能

背景:胫骨平台后外侧柱骨折是创伤骨科的难点,手术入路的选择是治疗的关键步骤之一,但目前对于入路选择尚无一个被多数学者接受的公认选择标准.目的:调查胫骨平台后外侧柱骨折的发病特点及发生率,探讨扩大外侧切口在后外侧柱骨折中的应用前景.方法:通过国际疾病代码从2009年7月至2019年3月福建医科大学附属闽东医院收治的患者病...

Adopting expanded lateral approach to enhance the mechanical stability and knee function for treating posterolateral column fracture of tibial plateau

BACKGROUND:The posterolateral column fracture on tibial plateau is the difficult point of traumatic orthopedics.The choice of operative approach is one of critical steps of treatment.However,nowadays there is not an acknowledged standard of choosing approach to be accepted by most scholars.OBJECTIVE:To investigate the characteristics and the incidence rate of posterolateral column fracture on tibial plateau,discuss the application prospect on adopting expanded lateral approach to treat the posterolateral column fracture.METHODS:The data of the patients with tibial plateau fractures were screened by International Classification of Disease Code from an electronic medical records database of the patients hospitalized in Mindong Hospital Affiliated to Fujian Medical University between July 2009 and March 2019.The Picture and Archiving Communication System was used to review the radiographic record on all patients’tibial plateau fractures.Schatzker classification and threecolumn classification was respectively used to classify the fracture types.The posterior column was divided into posterolateral and posteromedial column.The“independent posterolateral column fracture”was defined as a fracture whose main fragment disconnected with lateral and posteromedial columns’main body.The fracture characteristics of the posterolateral column were researched.The expanded lateral approach was adopted to treat 21 cases with displaced independent posterolateral column fractures.RESULTS AND CONCLUSION:(1)Totally 426 patients were enrolled,including 427 tibial plateau fractures.The posterolateral column fractures were involved in 267 cases and the“independent posterolateral column fractures”were involved in 126 cases.Totally 73 cases had lateral column fracture+displaced independent posterolateral column fracture within 4 cm under the articular surface on tibial plateau.(2)Twenty-one cases adopted expanded lateral approach obtained bony union.(3)It is concluded that expanded lateral approach suits lateral column+displaced independent posterolateral column fracture within 4 cm under the articular surface on tibial plateau.It will be singly adopted to treat Schatzker type II fracture or combined medial approach to treat Schatzker type V and VI fractures.The percentage of cases having the indication to adopt expanded lateral approach is about 17%in all tibial plateau fractures.The expanded lateral approach has a good application prospect.