Sun Hui, Zhai Qi-Lin, Xu Ya-Feng, Wang Yu-Kai, Luo Cong-Feng, Zhang Chang-Qing
Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 YiShan Road, Shanghai, 200233, China.
Arch Orthop Trauma Surg. 2015 Feb;135(2):209-221. doi: 10.1007/s00402-014-2131-4. Epub 2014 Dec 18.
This study aimed to investigate the surgical techniques and the clinical efficacy of combined approaches for the treatment of Schatzker type II tibial plateau fractures involving the posterolateral column [lateral and posterolateral columns (LPCs) fractures] in a prospective cohort.
From January 2007 through December 2010, a total of 65 patients with LPCs underwent dual-plate fixation via a combined anterior and posterior approach. The anterior and posterior approaches were the conventional anterolateral approach and a posteromedial inverted L-shaped approach, respectively, with the patients in a floating position.
Ultimately, 41 patients were followed up for a mean period of 52.5 months. All fractures healed. The mean time to radiographic bony union was 15.2 weeks and the mean time to full weight-bearing was 18.7 weeks. No parameter associated with knee alignment changed significantly between immediately postoperation and 2 years postoperation. No collapse of the reduced articular surface was detected. Two years postoperation, the mean Hospital for Special Surgery score was 92.3; the mean Short Form-36 score was 90.1, and the mean range of knee motion was 1.7°-123.6° (extension-flexion). Two patients suffered dehiscence of the anterolateral incision and another suffered partial necrosis at the margin of the posteromedial incision postoperatively. All healed in response conservative treatment. Another two patients experienced numbness in the posteromedial inferior region of the calf. No implant loosening, breakage, fixation failure, or other complication was observed during follow-up.
LPCs are not uncommon. Careful preoperative analysis of computed tomography images and impeccable preparation are necessary to avoid neglecting a posterolateral column fracture. It is inappropriate to generalize one scenario for all Schatzker type II fractures: a single approach cannot address all subtypes of these fractures. Dual-plate fixation via a combined approach is an effective treatment for LPCs.
本研究旨在探讨在一个前瞻性队列中，联合手术入路治疗累及后外侧柱的Schatzker II型胫骨平台骨折[外侧和后外侧柱（LPC）骨折]的手术技术及临床疗效。
2007年1月至2010年12月，共有65例LPC骨折患者采用前后联合入路进行双钢板固定。前路和后路分别采用传统的前外侧入路和后内侧倒L形入路，患者处于漂浮体位。
最终，41例患者获得随访，平均随访时间为52.5个月。所有骨折均愈合。影像学显示骨愈合的平均时间为15.2周，完全负重的平均时间为18.7周。术后即刻与术后2年之间，与膝关节对线相关的各项参数均无显著变化。未发现复位后的关节面塌陷。术后2年，特种外科医院（HSS）评分平均为92.3分；简明健康状况调查量表（SF-36）评分平均为90.1分，膝关节活动范围平均为1.7°-123.6°（伸展-屈曲）。2例患者出现前外侧切口裂开，另1例患者术后后内侧切口边缘出现部分坏死。经保守治疗后均愈合。另外2例患者出现小腿后内侧下部麻木。随访期间未观察到植入物松动、断裂、固定失败或其他并发症。
LPC骨折并不少见。术前仔细分析计算机断层扫描图像并做好完善准备，以避免遗漏后外侧柱骨折。对所有Schatzker II型骨折采用单一术式是不合适的：单一入路无法处理这些骨折的所有亚型。联合入路双钢板固定是治疗LPC骨折的有效方法。
