后内侧联合前外侧入路治疗胫骨平台外侧柱及后柱骨折

摘要

目的：探讨后内侧联合前外侧入路治疗胫骨平台外侧柱及后柱骨折的疗效。方法回顾性分析2012年4月～2015年2月收治的19例采取后内侧联合前外侧入路治疗胫骨平台后外侧柱及后柱骨折患者的临床资料，其中男性12例，女性7例；年龄21～72岁，平均38．1岁；左侧10例，右侧9例。致伤原因：道路交通伤12例，高处坠落伤5例，重物砸伤2例。所有患者均采用前外联合后内侧入路显露骨折、复位、植骨并钢板固定，同时修复合并的半月板、韧带损伤。通过比较术前健侧与术后即刻的胫骨平台内翻角（ PT角）、后倾角（ PS角）评价骨折的复位质量；通过比较术后即刻与术后12个月时的PT角、PS角评价骨折的愈合情况及内固定稳定性；同时，采用美国特种外科医院（ HSS）评分对膝关节功能进行评价。结果19例均获得随访，随访时间12～26个月，平均14．6个月；骨折临床愈合时间9～15周，平均14．2周；比较术前健侧与术后即刻、术后即刻与术后12个月时的PT、PS角，均无统计学差异（ P值分别为0．258、0．143、0．374、0．079）；术后12个月随访时的HSS评分为82～94分，平均86．7分。结论后内侧联合前外侧入路治疗胫骨平台外侧柱及后柱骨折疗效确切，有利于骨折复位、固定，术后膝关节功能恢复良好。%Objective To explore the effectiveness of combined posteromedial and anterolateral approaches for the treatment of lateral and posterior column tibial plateau fractures.Methods The clinical data of 19 patients [12 males and 7 females aged from 21-72(average 38.1) years] with posterior lateral and posterior tibial plateau fractures treated in our hospital from Apr.2012 to Feb.2015 were retrospectively analyzed.All patients were ex-posed to fracture,reduction,bone graft and plate fixation,and repair of the combined meniscus and ligament injury. Ten were on the left and 9 were on the right.The quality of the fracture reduction was evaluated by comparing PT and PS angle(healthy side and postoperative immediately).The healing of fracture and internal fixation stability were evaluated by comparing PT and PS angle( postoperative immediately and 12 months after surgery ) .HSS scores was used to evaluate the knee joint function.Results All of the 19 patients were followed up for 12-26 months,av-eraging 14.6 months.The clinical healing time of fracture was 9-15 weeks,with an average of 14.2 weeks.No sta-tistical difference was found in the comparison of PT and PS angle in the healthy side before the operation,immedi-ately after the operation and 12 months after surgery.HSS scores of all the patients were excellent and the mean score was 86.7(from 82 to 94).Conclusion The posterior medial and lateral approaches for the treatment of lat-eral tibial plateau fractures and posterior column fractures are effective,which is conductive to fracture reduction,fix-ation and postoperative knee function recovery.