后内侧联合前外侧入路治疗复杂胫骨平台骨折

Posteromedial and anterolateral approaches for open reduction and internal fixation of complex tibial plateau fractures

摘要:

[目的] 探讨后内侧联合前外侧入路治疗累及后内侧髁的复杂胫骨平台骨折的临床效果。[方法] 2017 年 4 月— 2021 年 3 月后内侧联合前外侧入路治疗累及后内侧髁的复杂胫骨平台骨折 33 例，观察临床及影像结果。[结果] 所有患者均顺利完成手术，术中无神经、血管损伤等严重并发症。所有患者随访 （23.5±8.3） 个月，恢复完全负重时间平均 （17.6±2.1） 周。与术后 3 个月相比，术后 12 个月及末次随访时，膝伸-屈 ROM、膝 HSS 评分均显著增加（P＜0.05），Rasmussen 评分差异无显著变化 （P＞0.05）。影像方面，与术后 3 个月相比，术后 12 个月及末次随访时 MPTA、PTS 无显著变化 （P＞0.05），33 例胫骨平台骨折均愈合，愈合时间 10~16 周。末次随访时，2 例出现关节间隙的中度狭窄，8 例存在膝关节明显的骨赘形成，较术后 3 个月及术后 12 个月均有明显的退变发生 （P＜0.05），但均未行二次手术治疗。[结论] 后内侧联合前外侧入路治疗累及后内侧髁的复杂胫骨平台骨折可以实现骨折的精确复位和坚强内固定，有利于膝关节早期功能锻炼，并发症少，临床疗效满意。

Abstract:

[Objective] To investigate the clinical efficacy of the posteromedial and anterolateral approaches for open reduction and in- ternal fixation (ORIF) of complex tibial plateau fractures involving the posteromedial plateau. [Methods] A total of 33 patients received OR- IF for complex tibial plateau fractures involving the posteromedial plateau through the posteromedial and anterolateral approaches in our de- partment from April 2017 to March 2021. The clinical and imaging results were observed. [Results] All patients were operated on success- fully without serious complications such as neurovascular injury, and were followed up for (23.5±8.3) months on an average, resumed full weight bearing in (17.6±2.1) weeks. Compared with those 3 months after surgery, the knee extension-flexion range of motion (ROM) and knee HSS scores significantly increased at 12 months after surgery and at the last follow-up (P＜0.05), whereas the Rasmussen score re- mained unchanged (P＞0.05). Radiographically, the MPTA and PTS had no significant changes at 12 months and the last follow-up com- pared with those 3 months after surgery (P＞0.05), while the tibial plateau fractures healed in all patients at 10~16 weeks postoperatively. At the last follow-up, 2 patients had moderate stenosis of joint space, 8 patients had obvious osteophyte formation of the knee joint, and the de- generation was significantly deteriorated at 12 months compared with that 3 months postoperatively (P＜0.05). However, no revision surgical operation was performed in anyone of them until the latest follow-up. [Conclusion] The posteromedial and anterolateral approaches for OR- IF of complex tibial plateau fractures involving the posteromedial plateau do achieve accurate reduction and firm internal fixation, which is conducive to early functional exercise of the knee joint, with few complications while satisfactory clinical efficacy.