目的：探讨膝关节后内侧双间隙切口治疗复杂胫骨平台后侧骨折的临床疗效。方法回顾性分析2012年2月-2013年11月收治的17例复杂胫骨平台后侧骨折，术前均经CT平扫及三维重建检查，明确骨折类型、部位，均采用膝关节后内侧双间隙切口暴露骨折端，用3.5 mm的可塑性重建锁定接骨钢板、4.0 mm或4.5 mm中空螺钉固定骨折端。1例伴有内侧半月板及内侧副韧带损伤，通过该切口Ⅰ期处理，2例伴后交叉韧带断裂，3个月后待骨性愈合，在膝关节镜下行交叉韧带重建。结果所有患者切口均甲级愈合，其中2例切口稍红，予局部换药、酒精纱布湿敷等处理后好转。所有患者未出现皮肤坏死、神经损伤、骨不愈合、内固定松动等情况，未见明显膝关节内、外翻畸形。膝关节功能评分优良率90.1%。结论膝关节后内侧双间隙切口治疗复杂胫骨平台后侧骨折有优势，能良好地暴露骨折端，坚强内固定，使患者早期功能锻炼，减少并发症。%Objective To investigate the clinical efficacy of knee posteromedial double gap incision on complex posterior tibial plateau fracture. Methods A retrospective analysis of 17 cases of complex tibial plateau posterior fractures, preoperatively diagnosed by CT scan and three-dimensional reconstruction check to make clear fracture type, location, adopt the posteromedial knee double gap incision exposure of the fracture site, with plastic reconstruction of 3.5 mm locking bone plate, 4.0 mm or 4.5 mm hollow screw fixation. Patients with medial meniscus and medial collateral ligament injury, through the incision treatment, two patients with fracture of the posterior cruciate ligament, after 3 months, in knee arthroscopic reconstruction of the anterior cruciate ligament. Results All patient's incision healed, 2 cases incision slightly red, after changing dressing, and alcohol gauze wet compress incision occurred better, all the patients had no skin necrosis, nerve injury, bone nonunion, internal fixation loosening and so on, there was no obvious knee valgus deformity, knee joint function scoring, the excellent and good rate: 90.1%. Conclusion The medial posterior knee double gap incision for the treatment of complex tibial plateau posterior fractures has the advantage of good exposure, fracture, rigid internal fixation, the early functional exercise of patients, reduce complications.
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