Department of Trauma and Reconstructive Surgery, Asklepios Clinic St Georg, Hamburg, Germany.
J Orthop Trauma. 2010 Aug;24(8):515-20. doi: 10.1097/BOT.0b013e3181e5e17d.
The selection of a surgical approach for the treatment of tibia plateau fractures is an important decision. Approximately 7% of all tibia plateau fractures affect the posterolateral corner. Displaced posterolateral tibia plateau fractures require anatomic articular reduction and buttress plate fixation on the posterior aspect. These aims are difficult to reach through a lateral or anterolateral approach. The standard posterolateral approach with fibula osteotomy and release of the posterolateral corner is a traumatic procedure, which includes the risk of fragment denudation. Isolated posterior approaches do not allow sufficient visual control of fracture reduction, especially if the fracture is complex. Therefore, the aim of this work was to present a surgical approach for posterolateral tibial plateau fractures that both protects the soft tissue and allows for good visual control of fracture reduction. The approach involves a lateral arthrotomy for visualizing the joint surface and a posterolateral approach for the fracture reduction and plate fixation, which are both achieved through one posterolateral skin incision. Using this approach, we achieved reduction of the articular surface and stable fixation in six of seven patients at the final follow-up visit. No complications and no loss of reduction were observed. Additionally, the new posterolateral approach permits direct visual exposure and facilitates the application of a buttress plate. Our approach does not require fibular osteotomy, and fragments of the posterolateral corner do not have to be detached from the soft tissue network.
治疗胫骨平台骨折的手术入路选择是一个重要的决策。大约 7%的胫骨平台骨折会影响后外侧角。移位的胫骨平台后外侧骨折需要进行解剖关节复位，并在后侧使用支撑钢板固定。通过外侧或前外侧入路很难达到这些目标。带有腓骨截骨和后外侧角松解的标准后外侧入路是一种创伤性手术，包括骨块剥脱的风险。单纯的后入路无法提供足够的骨折复位视觉控制，尤其是骨折复杂时。因此，本研究旨在介绍一种既能保护软组织又能很好地控制骨折复位的胫骨平台后外侧骨折手术入路。该入路通过外侧关节切开术来观察关节面，通过后外侧入路进行骨折复位和钢板固定，两者均通过一个后外侧皮肤切口完成。使用这种方法，我们在最后一次随访时，有 6 例/7 例患者达到了关节面的复位和稳定固定。未观察到并发症和复位丢失。此外，新的后外侧入路允许直接进行可视化暴露，并便于使用支撑钢板。我们的方法不需要进行腓骨截骨，后外侧角的骨块也不必从软组织网络中分离。
