Yu Baoqing, Han Kaiwei, Zhan Ce, Zhang Chuncai, Ma Hui, Su Jiachan
Department of Orthropaedics, Changhai Hospital, The Second Military Medical University, Shanghai 200433, China.
Knee. 2010 Oct;17(5):313-8. doi: 10.1016/j.knee.2010.01.002. Epub 2010 Feb 18.
A variety of surgical approaches have been employed previously for the open reduction and internal fixation of the fractures of lateral and posterolateral tibial plateau. However, the commonly used lateral approach does not provide adequate exposure and access to the posterolateral aspect of the lateral tibial plateau. We developed a new approach with osteotomy of fibular head to solve this problem and report its preliminary result.
Eighty-two patients with lateral or posterolateral tibial plateau fractures had been treated by this approach. According to the fractures, partial or full heads of the fibula were removed, and knee joint function, including stability of the knee, was evaluated by X-ray and physical examinations.
All 82 cases were followed up for a mean of 3.2 y 2.0-5.6 y). In each case, the fractures were completely healed and knee joint function was restored. No infection or skin and bone necrosis were found. After one year following the operation, functional assessment of the knee joints by Rasmussen's functional grading system revealed a mean score of 27.9 (24-30). In addition, the radiological assessment by Rasmussen's anatomical grading system resulted in a mean score of 16.8 (14-18). Six patients experienced occasional pain or bad wither pain around knee joints, three of which had lateral-longitudinal instability of knee joint and three lost height of the tibial plateau.
The new approach provides excellent visualization, which can facilitate the reduction and internal fixation for lateral or posterolateral tibial plateau fractures, and shows encouraging results.
以往曾采用多种手术方法对胫骨外侧和后外侧平台骨折进行切开复位内固定。然而，常用的外侧入路不能充分显露和进入胫骨外侧平台的后外侧。我们开发了一种新的带腓骨头截骨的入路来解决这一问题，并报告其初步结果。
82例胫骨外侧或后外侧平台骨折患者采用该入路治疗。根据骨折情况，切除部分或全部腓骨头，通过X线和体格检查评估膝关节功能，包括膝关节稳定性。
82例均获随访，平均随访3.2年（2.0 - 5.6年）。所有病例骨折均完全愈合，膝关节功能恢复。未发现感染及皮肤、骨坏死。术后1年，采用拉斯穆森功能评分系统对膝关节进行功能评估，平均得分为27.9分（24 - 30分）。此外，采用拉斯穆森解剖评分系统进行影像学评估，平均得分为16.8分（14 - 18分）。6例患者膝关节周围偶尔出现疼痛或轻度疼痛，其中3例存在膝关节外侧纵向不稳定，3例胫骨平台高度丢失。
新入路提供了良好的视野，有助于胫骨外侧或后外侧平台骨折的复位和内固定，且结果令人鼓舞。
