Chen Cheng-Wei, Chen Lei, Pan Zhe-Er, Yang Sheng-Wu
Department of Orthopaedics, the First Affiliated Hospital of Wenzhou Medical College, Wenzhou 325000, Zhejiang, China.
Zhongguo Gu Shang. 2012 Jul;25(7):561-5.
To discuss the fracture patterns,operative procedures and clinical results of open reduction and internal fixation via a posterior approach to treat posterior fractures of tibial plateau.
From June 2008 to February 2011, 8 patients with posterior tibial plateau fractures treated with posterior approach, were reviewed retrospectively. There were 5 males and 3 females,with an average of 41.1 years ranging from 23 to 55. Of the 8 cases, 5 cases were caused by traffic accidents, 3 caused by fall. Two cases of posterior coronal fractures combined with avulsion of posterior cruciate ligament and 1 case of posterolateral fractures associated with collapse fractures was treated via a S-shaped approach, 2 cases of posteromedial fracture via a posteromedial reversed L-shaped approach, another 3 cases of complex fractures involving anterior and posterior of tibial plateau, and metaphsis via a posteromedial reversed L-shaped approach combined with anterolateral approach. Fractures with articular surface collapse were applied with bone grafting.
All the 8 cases were followed up for 8 to 39 months (means 20 months). All cases had attained bone union, the time of bone healing was 14.5 weeks in average ranging from 11 to 21 weeks. No infection, no blood vessel or nerve injuries and loosening or breakage of screw were found. There were no significant differences about the tibial plateau angle (TPA) and the posterior slope angle (PA) on radiographies between immediately after operation and 6 months after operation. According to the Rasmussen functional scoring,the results were excellent in 4, good in 3, fair in 1. Radiologic results were graded with the Rasmussen score to evaluate the reduction of the fracture, the scores at last followed-up was 14 to 18 scores (means 17.25), the results were excellent in 6, good in 2.
Posterior S-shaped or L-shaped approach can facilitate the reduction and fixation with good exposure for posterior fractures of tibial plateau.
探讨经后路切开复位内固定治疗胫骨平台后髁骨折的骨折类型、手术方法及临床疗效。
回顾性分析2008年6月至2011年2月采用后路手术治疗的8例胫骨平台后髁骨折患者的临床资料。其中男5例，女3例，平均年龄41.1岁（23～55岁）。8例中，交通伤5例，坠落伤3例。2例后髁冠状骨折合并后交叉韧带撕脱伤及1例后外侧骨折合并塌陷骨折采用S形入路，2例后内侧骨折采用后内侧倒L形入路，另3例累及胫骨平台前后及干骺端的复杂骨折采用后内侧倒L形入路联合前外侧入路。关节面塌陷骨折予以植骨。
8例患者均获随访，随访时间8～39个月，平均20个月。所有患者骨折均愈合，骨折愈合时间平均14.5周（11～21周）。无感染、血管神经损伤及螺钉松动断裂等并发症发生。术后即刻与术后6个月X线片测量胫骨平台角（TPA）及后倾角（PA）差异无统计学意义。根据Rasmussen功能评分：优4例，良3例，可1例。采用Rasmussen放射学评分评价骨折复位情况，末次随访时评分14～18分，平均17.25分，优6例，良2例。
后路S形或L形入路能充分暴露骨折，便于胫骨平台后髁骨折的复位与固定。
