目的：探讨伴有后柱损伤的SchatzkerⅤ、Ⅵ型胫骨平台骨折的治疗策略及临床疗效。方法回顾性分析2010年6月～2013年5月手术治疗的22例伴有后柱损伤的SchatzkerⅤ、Ⅵ型胫骨平台骨折患者的治疗效果。术前常规行三维CT扫描明确骨折类型及移位情况，采用前外侧切口联合后内侧切口、双钢板内固定，其中12例接受自体骨植骨，术后早期行不负重功能锻炼。根据美国纽约特种外科医院（ HSS）评分标准进行功能评价。结果22例均获满意复位，其中19例术后得到10～22个月随访，平均16．6个月，均达到骨性愈合。 HSS评分58～92分，平均83．12分，其中优8例，良8例，可2例，差1例；优良率为84％（16／19）。结论前外侧切口联合后内侧切口、双钢板内固定治疗伴有后柱损伤的SchatzkerⅤ、Ⅵ型胫骨平台骨折可有效恢复膝关节的力线及关节面平整，结合早期不负重功能锻炼可获得较好的临床效果。%Objective To investigate the therapeutic strategy and clinical effectiveness of Schatzker type Ⅴand Ⅵtibial plateau fracture with posterior column injury .Methods The therapeutic effects of 22 patients with Schatzker type Ⅴand Ⅵtibial plateau fracture with posterior column injury from Jun .2010 to May 2013 were sum-marized and analyzed .Conventional pre-operative three-dimensional CT scans were used to define fracture type and displacement .The anterolateral incision combined with posteromedial incision and double plate internal fixation was applied.Twelve patients were implanted with autograft bone and did not perform early weight -bearing functional ex-ercises after operation .Functional evaluation was conducted according to the scoring criteria of USA New York Hos -pital for Special Surgery ( HSS) .Results All 22 patients obtained satisfactory reduction ,of whom 19 patients had bony union after 10-22 months follow-up post-operatively (median follow-up period,16.6 months).The average HSS was 83.12 (range,58-92),indicating 8 excellent cases,8 good cases,2 fair cases and 1 poor case;the excel-lent and good rate was 84%(16 of 19).Conclusion The anterolateral incision combined with posteromedial inci-sion and double plate internal fixation for treating Schatzker type ⅤandⅥtibial plateau fracture with posterior col-umn injury can effectively restore the alignment and joint surface ,and can obtain good clinical effect with early non-weight bearing exercises .
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