Meng De-peng, Ye Tian-wen, Chen Ai-min
Department of Orthopedic Surgery, Changzheng Hospital, The Second Military Medical University, 415 Fengyang Road, Huangpu District, Shanghai 200003, China.
J Orthop Surg Res. 2014 Apr 15;9:26. doi: 10.1186/1749-799X-9-26.
This study investigates the safety and efficacy of anterolateral (AL) osteotomy for the treatment of lateral tibial plateau fractures merged with relatively simple and intact posterolateral (PL) corner displacement and screens applicable patients.
Totally, 11 patients with lateral tibial plateau fractures involving the PL corner were included in this study. Of them, seven patients sustained their injuries from motor vehicle accidents (MVAs), three from sports and one from fall from height. All of them received open reduction and internal fixation through the AL approach. Operation time, incision length, range of motion (ROM), Hospital for Special Surgery (HSS) knee score, time of union and complications were retrospectively reviewed. Tibial plateau angle (TPA), lateral posterior slope angle (PSA) and articular step-off reduction after surgery were examined by a radiograph technique.
Statistically, the means of operation time, incision length, ROM and follow-up period were 82 min, 11 cm, 97° and 27 months, respectively. Three patients had slight complications: superficial infection, hardware irritation and secondary valgus deformity, without severe neural or vascular injuries, which revealed the safety and efficacy of the PL treatment. The average HSS knee score was 91.2 (range 86-96). Reduction (mean TPA 87.2° and mean PSA 8.3°) was satisfactory in 10 patients, except for one patient with a radiographic articular step-off of 5 mm (case 10).
The AL approach is safe and effective for lateral tibial plateau fractures involving the PL corner, especially for fractures merged with simple and intact PL corner displacement (depression and/or split).
本研究探讨前外侧（AL）截骨术治疗合并相对简单且完整的后外侧（PL）角移位的胫骨外侧平台骨折的安全性和有效性，并筛选适用患者。
本研究共纳入11例累及PL角的胫骨外侧平台骨折患者。其中，7例患者因机动车事故（MVA）受伤，3例因运动受伤，1例因高处坠落受伤。所有患者均通过AL入路进行切开复位内固定。回顾性分析手术时间、切口长度、活动范围（ROM）、特种外科医院（HSS）膝关节评分、愈合时间及并发症情况。采用X线片技术检查术后胫骨平台角（TPA）、外侧后倾角（PSA）及关节台阶复位情况。
统计学分析显示，手术时间、切口长度、ROM及随访时间的均值分别为82分钟、11厘米、97°及27个月。3例患者出现轻微并发症：浅表感染、内固定刺激及继发性外翻畸形，无严重神经或血管损伤，表明PL治疗的安全性和有效性。HSS膝关节评分平均为91.2（范围86 - 96）。除1例患者X线片显示关节台阶为5毫米（病例10）外，10例患者复位情况（平均TPA 87.2°，平均PSA 8.3°）满意。
AL入路治疗累及PL角的胫骨外侧平台骨折安全有效，尤其适用于合并简单且完整的PL角移位（凹陷和/或劈裂）的骨折。
