Sun Hui, Zhu Yi, He Qi-Fang, Shu Lin-Yuan, Zhang Wei, Chai Yi-Min
Department of Orthopaedic Surgery, Shanghai Jiao Tong University, Affiliated Sixth People's Hospital, 600 YiShan Road, Shanghai, 200233, China.
Department of Emergency, Shanghai Jiao Tong University, Affiliated Sixth People's Hospital, 600 YiShan Road, Shanghai, 200233, China.
Injury. 2017 Dec;48(12):2814-2826. doi: 10.1016/j.injury.2017.10.033. Epub 2017 Oct 31.
A posterolateral column fracture of the tibial plateau (PLCF) is not uncommon, especially lateral and bicondylar tibial plateau fractures. Currently, there is no consensus on the methods of surgical treatment for PLCF, including the surgical approach or the fixation strategy. Though various posterior approaches have been explored and can allow posterior buttress plate fixation, the necessity of a posterior approach with fixation for PLCFs is increasingly questioned. Meanwhile, there is no literature to analyse the morphological features of PLCFs. None of the available surgical techniques can solve all of the problems of PLCFs.
From February 2016 to June 2016, an inconsecutive series of 16 patients who suffered Schatzker type II tibial plateau fractures involving the posterolateral column were selected based on an analysis of the morphological characteristics of PLCFs. The patients were all treated by lateral rafting plate fixation with magic screw implantation through the extended lateral approach.
According to PLCF morphology, 4 patients had mild slope-type depression fractures (MSDF) of the articular surface, and the other 12 patients had block-type splitting fractures (BSF). After a 12-month follow-up period, there were no complications related to the fixation technique and no significant changes in limb alignment. At the final follow-up, the average range of motion (ROM) of the affected knees was 2.3°-125°, and the average HSS score was 94.2.
The selected patients who suffered Schatzker type II fractures involving the posterolateral column could be successfully treated via lateral rafting plate fixation with the magic screw technique. For PLCF treatment, magic screw fixation is a valuable technique that may reduce the utilization of posterior approaches and posterior fixations.
胫骨平台后外侧柱骨折（PLCF）并不少见，尤其是外侧和双髁胫骨平台骨折。目前，对于PLCF的手术治疗方法，包括手术入路或固定策略，尚无共识。尽管已经探索了各种后入路，并且可以进行后支撑钢板固定，但对于PLCF采用后入路固定的必要性受到越来越多的质疑。同时，尚无文献分析PLCF的形态学特征。现有的手术技术都无法解决PLCF的所有问题。
基于对PLCF形态学特征的分析，选取2016年2月至2016年6月间16例Schatzker II型胫骨平台骨折累及后外侧柱的非连续病例。所有患者均采用经扩大外侧入路外侧漂浮钢板固定并植入魔术钉治疗。
根据PLCF形态，4例患者为关节面轻度斜坡型凹陷骨折（MSDF），其余12例为块状劈裂骨折（BSF）。经过12个月的随访，未出现与固定技术相关的并发症，肢体对线也无明显变化。末次随访时，患膝平均活动范围（ROM）为2.3° - 125°，平均HSS评分为94.2。
所选的Schatzker II型骨折累及后外侧柱的患者可通过外侧漂浮钢板结合魔术钉技术成功治疗。对于PLCF的治疗，魔术钉固定是一种有价值的技术，可能会减少后入路和后固定的使用。
