后侧胫骨平台骨折的手术治疗

目的探讨治疗后侧胫骨平台骨折的手术入路及内固定安放技巧。方法对上海市第八人民医院2009年1月至2011年1月收治的38例后侧胫骨平台骨折患者的临床资料进行回顾性分析，所有骨折均采用后内侧经鹅足与腓肠肌间隙入路，骨折复位后T形或L形钢板进行内固定。结果患者均获随访，随访时间13～21个月，平均（15．0±0．6）个月。手术时间52～110min，平均（87±8）min。术后恢复顺利，骨折愈合时间9—13周，平均（11．4±0．4）周。术后12周，92．1％（35／38）的患者膝关节屈曲达到120°。术后1年，参照美国特种外科医院膝关节评分标准，优良率达到94．7％（36／38）。无感染及骨折不愈合患者，无内固定松动患者。结论膝关节后内侧经鹅足与腓肠肌内侧头间隙入路能充分显露后侧胫骨平台骨折，经该手术入路进行后侧胫骨平台骨折的固定安全便捷，能获得良好的疗效。

Surgical treatment of posterior tibail plateau fractures

Objective To explore the effective approach to expose the posterior tibial plateau fractures and the technique to fix the fractures. Methods From January 2009 to January 2011, 38 cases of posterior tibial plat- eau fractures underwent surgical treatment in our hospital. All the fractures were exposed by posteromedial approach via the interval between pes ancerenus and medial gastrocnemius. The fractures were fixed with ＂L＂ or ＂T＂ plates. Results All the patients were followed up 13-21 months [ average （15.0 ± 0.6） months ]. The surgical time were 52-110 minutes [ average （87 ± 8） minutes]. The time for fracture union were 9-13 weeks [ average （ 11.4 ± 0.4） weeks]. 92.1% （35/38） of the patients recovered with a knee range of motion more than 120 degrees within 12 weeks postoperative. At one year posterative, according to the HSS scoring system, the rate of excellent and good was 94. 7% （36/38）. There was no infection, no nonunion and no loosening or breakage of the plates. Conclusion The posterior tibial plateau fractures can be well exposed and fixed by the posteromedial approach via the interval between pes ancerenus and medial gastrocnemius.