膝后内倒L入路非对称T形板固定胫骨平台双后柱骨折△（开放获取）

An asymmetric T-plate through inverted retrogenicular L-approach for internal fixation of posterior bi-column tibial plateau fractures

摘要:

[目的] 探讨非对称 T 形锁定板经膝后内侧倒 L 入路治疗胫骨平台双后柱骨折的临床效果。[方法] 2017 年 1 月— 2021 年 1 月收治的累及胫骨平台双后柱骨折患者 21 例，采用经膝关节后内侧倒 L 入路，骨折复位后选用非对称 T 形锁定板固定。评价临床和影像结果。[结果]患者均顺利完成手术，无血管、神经损伤等并发症。随访时间平均（17.6±3.9）个月，随术前，术后 3 个月和末次随访的时间推移，VAS 评分显著减少 [(8.1±0.7), (2.5±0.5), (1.1±0.8), P＜0.001]，HSS 评分 [(34.1±3.1), (78.3±2.2), (90.3±2.1), P＜0.001]、膝伸-屈 ROM [(10.1±2.6)°, (92.4±6.2)°, (115.7±6.9)°, P＜0.001] 显著增加。影像方面，随时间推移，Rasmussen 影像评分 [(8.3±1.3), (15.9±0.9), (15.8±0.9), P＜0.001] 显著增加，胫骨平台后倾角 （posterior slope angle, PSA） [(19.0±1.2)°, (9.3±1.7)°, (9.4±1.8)°, P＜0.001]、胫骨平台内翻角 （tibial plateau varus angle, TPVA） [(93.1±1.5)°, (87.1±1.7)°, (87.2± 1.8)°, P＜0.001] 均显著减小。[结论]采用非对称 T 形锁定板经膝后内倒 L 入路治疗胫骨平台双后柱骨折，可以获得较好的骨折复位和内固定效果，术后膝关节功能恢复良好。

Abstract:

[Objective] To investigate the clinical outcome of asymmetric T-shaped locking plate used for internal fixation of posterior bi-column tibial plateau fractures through the posteromedial inverted L approach. [Methods] From January 2017 to January 2021, 21 patients received asymmetric T-shaped locking plate for internal fixation of posterior bi-column tibial plateau fractures through the postero medial inverted L approach. The clinical and imaging documents were evaluated. [Results] All patients had operation performed successfully without vascular and nerve injury, and were followed up for (17.6±3.9) months on an average. With time preoperatively, 3 months after surgery and the last follow-up, the VAS score decreased significantly [(8.1±0.7), (2.5±0.5), (1.1±0.8), P＜0.001], while the HSS score [(34.1± 3.1), (78.3±2.2), (90.3±2.1), P＜0.001], knee extension-flexion ROM [(10.1±2.6)°, (92.4±6.2)°, (115.7±6.9)°, P＜0.001] increased significantly. As for image, the Rasmussen image score [(8.3±1.3), (15.9±0.9), (15.8±0.9), P＜0.001] increased significantly, whereas the posterior tibial slope (PTS) [(19.0±1.2)°, (9.3±1.7)°, (9.4±1.8)°, P＜0.001], tibial plateau varus angle (TPVA) [(93.1±1.5)°, (87.1±1.7)°, (87.2±1.8)°, P＜0.001] were significantly decreased over time. [Conclusion] The asymmetric Tshaped locking plate through posterior inverted L approach for internal fixation of posterior bi-column tibial plateau fractures does achieve good consequences in terms of fracture reduction and internal fixation stability, and the knee function recovery.