Zhang Peng, Lian Kejian, Luo Deqing, Huang Zunxian, Li Teng, Lin Dasheng
Department of Orthopaedic Surgery, The Affiliated Southeast Hospital of Xiamen University, Zhangzhou, China.
Department of Orthopaedic Surgery, The Affiliated Southeast Hospital of Xiamen University, Zhangzhou, China; Experimental Surgery and Regenerative Medicine, Department of Surgery, Ludwig Maximilians University, Munich, Germany.
Injury. 2016 Oct;47(10):2326-2330. doi: 10.1016/j.injury.2016.07.004. Epub 2016 Jul 5.
The treatment of tibial plateau fractures involving the lateral and posterolateral column is a demanding and fine surgical challenge. The purpose of this study was to evaluate the safety and clinical efficacy of combined approach for the treatment of lateral and posterolateral tibial plateau fractures.
A prospective study was performed in 17 patients with lateral and posterolateral tibial plateau fractures between January 2009 and December 2012. There were 12 males and 5 females with a mean age of 40 years. All of them received dual-plate fixation through the combined approach, with the patients in a floating position. The combined approaches included a conventional anterolateral approach and an inverted L-shaped posterolateral approach. Operation time, intraoperative blood loss, fracture healing time, Hospital for Special Surgery (HSS) knee score, knee flexion and extension range of motion, and complications were recorded to evaluate treatment effects.
There were no intraoperative complications related to this technology. Mean operation time was 144min with a mean intraoperative blood loss volume of 233mL. The mean follow-up was 23 months. All 17 patients had good postoperative fracture healing. Mean union time was 12 weeks. At the final follow-up, the average HSS score was 92.5, with the average knee flexion of 125° and an average knee extension of 2°. Two patients had complications in postoperative incisions with aseptic fat liquefaction. After thorough debridement, second-stage wounds healing were achieved. No neurovascular injury occurred. No collapse of reduced articular surface was detected.
The combined approach with dual-plate offers direct and complete surgical exposure and provide an effective method for the treatment of lateral and posterolateral tibial plateau fractures.
治疗涉及外侧和后外侧柱的胫骨平台骨折是一项要求苛刻且精细的外科挑战。本研究的目的是评估联合入路治疗外侧和后外侧胫骨平台骨折的安全性和临床疗效。
对2009年1月至2012年12月期间17例外侧和后外侧胫骨平台骨折患者进行前瞻性研究。其中男性12例，女性5例，平均年龄40岁。所有患者均采用联合入路双钢板固定，患者处于漂浮体位。联合入路包括传统的前外侧入路和倒L形后外侧入路。记录手术时间、术中出血量、骨折愈合时间、特种外科医院（HSS）膝关节评分、膝关节屈伸活动范围及并发症，以评估治疗效果。
术中无与该技术相关的并发症。平均手术时间为144分钟，平均术中出血量为233毫升。平均随访23个月。17例患者术后骨折均愈合良好。平均愈合时间为12周。末次随访时，平均HSS评分为92.5分，平均膝关节屈曲125°，平均膝关节伸直2°。2例患者术后切口出现无菌性脂肪液化并发症。经彻底清创后，二期伤口愈合。未发生神经血管损伤。未发现复位后的关节面塌陷。
双钢板联合入路提供了直接且完全的手术显露，为治疗外侧和后外侧胫骨平台骨折提供了一种有效的方法。
