Objective To study the new computed tomographic (CT) classification, surgical approaches and clinical efficacy of posterior condylar tibial plateau fractures. Methods From January 2006 to July 2009, a total of 39 patients of posterior condylar tibial plateau fractures were treated by posteromedial and posterolateral knee approaches. There were 23 males and 16 females. The mean age was 41.6 years old (range:28 -68). Among all patients, the causes were traffic accidents (n =26), falls (n =9) and other injuries (n=4). By CT classification, there were type Ⅰ with posteromedial condylar tibial plateau split fracture(n=7), type Ⅱ with posterolateral condylar tibial plateau split fracture (n=5), type Ⅲ with posterolateral condylar tibial plateau depression fracture (n=11), type Ⅳ with posterolateral condylar tibial plateau split depression fracture(n=2) and type Ⅴ with posteromedial split and posterolateral condylar tibial plateau depression fracture (n=14). Results The mean follow-up period was 18.1 months (range:12-30). The radiographic bony union time was 11 -16 weeks (mean:15.2) and the full weight-bearing time 12-20 weeks (mean:15.6). No infection, knee varus/valgus, nerve injury or screw loosening/breakage was found. Bony union was achieved in all cases. According to the Rasmussen functional scoring, the results were excellent in 20, good in 14 and fair in 5. And the excellent and good rate was 87. 2%. The radiological results were graded with the Rasmussen score to evaluate the reduction of fracture. The outcome was excellent in 28, good in 8 and fair in 3. And the excellent and good rate was 92.3%. Conclusion This new CT classification scheme of posterior condylar tibial plateau fractures can significantly improve the reliability,guide the clinicians to select appropriate treatment plans and design an ideal regimen of operative approach and internal fixation.%目的 探讨新的胫骨平台后髁骨折的CT分型、手术方法及临床疗效.方法 2006年1月至2009年7月,采用后侧入路手术治疗胫骨平台后髁骨折获得随访的患者39例,男23例,女16例;年龄26～68岁,平均41.6岁.致伤原因:车祸伤26例,高处坠落伤9例,其他伤4例.应用CT分型:Ⅰ型,后内髁劈裂骨折7例;Ⅱ型,后外髁劈裂骨折5例;Ⅲ型,后外髁塌陷骨折11例;Ⅳ型,后外髁劈裂塌陷骨折2例;Ⅴ型,后内髁劈裂及后外髁塌陷骨折14例.结果 本组39例均获随访,时间12～30个月,平均18.1个月.骨折愈合时间为11～16周,平均15.2周;完全负重时间为12～20周,平均15.6周.无切口感染,无术中血管神经损伤,无内固定松动及断裂,无骨不愈合,无膝关节内、外翻畸形和骨折再移位.术后根据Rasmussen膝关节功能评定评分标准:优20例,良14例,可5例,差0例,优良率为87.2%.骨折复位满意度用Rasmussen放射学评分标准评价,优28例,良8例,可3例,差0例,优良率为92.3%.结论 基于三维CT的胫骨平台后髁骨折分型可明显提高骨折分类的可靠性,有利于临床医生选择合适的治疗计划、决定手术入路及内固定方法,是胫骨平台后髁骨折有价值的分型方法.
展开▼
