Hong Feng, Wang Nan, Chen Guan-Jun
Xiaoshan Traditional Chinese Medical Hospital, Hangzhou 311200, Zhejiang, China;
Xiaoshan Traditional Chinese Medical Hospital, Hangzhou 311200, Zhejiang, China.
Zhongguo Gu Shang. 2016 Nov 25;29(11):1027-1032. doi: 10.3969/j.issn.1003-0034.2016.11.011.
To study the clinical therapeutic effects of posterior medial approach inverted L-shaped incision combined with reconstruction plate fixation in treating posterior tibial plateau condylar fracture.
From February 2011 to February 2015, 19 patients that were clearly diagnosed with combined posterior tibial plateau condylar fracture were treated with internal fixation of reconstruction plate through the posterior medial approach L-shaped incision under direct vision, involved 14 males and 5 females with an average age of 45.5 years ranging from 28 to 71 years. The intervals between injury and operation ranged from 6 to 15 days with a mean of 9.2 days. According to Schatzker Classification, there were 6 cases in type II, 2 in type IV, 7 in type V, 4 in type VI In accordance with the three-column theory proposed by Luo Congfeng, 2 cases were medial column combined with posterior column fracture, 6 were lateral column combined with posterior column fracture, and 11 were three-column fracture. The major clinical symptoms before treatment were swelling and deformity of the knee, as well as limitation of motion. X-ray and CT examination were completed. The American Hospital for Special Surgery score(HSS) was used to evaluate clinical effect.
One case developed skin infection in the posteromedial incision postoperatively, but other complications, such as neurovascular injury, deep venous thrombosis of lower limb, cracking and failure of internal fixation, and fracture re-displacement were not seen. The patients were followed up for an average of 12.5 months (10 to 24 months). The fracture healing time ranged from 5 to 11 months with a mean of 8.2 months. According to HSS, the total score was 82.1±7.3, 9 patients got an excellent result, 7 good, 2 poor and 1 bad. Regular postoperative re-check X-ray indicated that all fracture showed stage I healing. The difference was not significant on varus angle, post-dip angle and femorotibial angle between 3 days and 1 year after operaiton.
Treating the posterior tibial plateau condylar fracture through the posterior medial approach L-shaped incision of the knee rendered sufficient exposure, little injury, as well as convenient and effective installation of internal fixation. Reconstruction plate possessed the advantages of good plasticity, strong supportability, small implant volume, together with low cost;and the structural and functional recovery of the knee could achieve satisfying clinical therapeutic effects as combined with appropriate postoperative rehabilitation training.
探讨后内侧入路倒L形切口联合重建钢板内固定治疗胫骨平台后髁骨折的临床疗效。
选取2011年2月至2015年2月明确诊断为胫骨平台后髁骨折的患者19例，采用后内侧入路L形切口直视下重建钢板内固定治疗，其中男14例，女5例；年龄28～71岁，平均45.5岁。受伤至手术时间6～15 d，平均9.2 d。按Schatzker分型：Ⅱ型6例，Ⅳ型2例，Ⅴ型7例，Ⅵ型4例。按照罗从风提出的三柱理论分型：内后侧柱联合骨折2例，外后侧柱联合骨折6例，三柱骨折11例。治疗前主要临床症状为膝关节肿胀、畸形、活动受限。完善X线及CT检查。采用美国特种外科医院（HSS）评分评价临床疗效。
术后1例患者出现后内侧切口皮肤感染，未出现神经血管损伤、下肢深静脉血栓形成、内固定物断裂失效、骨折再移位等其他并发症。患者平均随访12.5个月（10～24个月）。骨折愈合时间5～11个月，平均8.2个月。按HSS评分：总分82.1±7.3分，优9例，良7例，可2例，差1例。术后定期复查X线示骨折均达Ⅰ期愈合。术后3 d与术后1年的内翻角、后倾角及股胫角差异无统计学意义。
采用膝关节后内侧入路L形切口治疗胫骨平台后髁骨折，显露充分，损伤小，内固定安装方便、有效。重建钢板塑形好、支撑力强、植入物体积小、费用低，结合术后适当康复训练，膝关节结构及功能恢复可达到满意的临床疗效。
