Zhao Y W, Xie J B, Ding G Z
Department of Traumatic Orthopaedics, the First Affiliated Hospital of Wannan Medical College, Wuhu 241001, China.
Zhonghua Yi Xue Za Zhi. 2018 Jan 30;98(5):352-356. doi: 10.3760/cma.j.issn.0376-2491.2018.05.007.
To explore the short-term effects of expanded anterolateral approach in treating fracture involved the posterolateral tibial plateau. A retrospective analysis of the clinical data from 16 patients undergoing extended anterolateral approach for fracture involved the posterolateral tibial plateau in the First Affiliated Hospital of Wannan Medical College between January 2013 and July 2016 was done. The patients were treated with 3.5 mm proximal "L" type proximal tibial locking compression plate with four locking screws through the nail row technique. The X-rays examinations were carried out immediately after the operation and at 1.5, 3, 6, and 12 months later, to continuously measure the tibial plateau angle (TPA) and posterior slope angle (PA). The Rasmussen radiology score was used to assess the reduction. One year later, the modified Rasmussen knee score was used to assess the recovery of knee function, the Lysholm score was applied to evaluate the cartilage injury, softening and degeneration, and lateral stress test and dial test were carried out to evaluate the stability of the knee. The group consisted of 11 males and 5 females; aged 25 to 71 years, mean (47±12) years; schatzker type Ⅱ 9 cases, type Ⅴ 6 cases and type Ⅵ 1 case. There were 9 cases of type B in Orthopedic Trauma Association (OTA) classification, and 7 cases of type C. X-ray was immediately performed after operation and it showed that 14 cases got anatomic reduction, 2 cases left<2 mm of steps. Rasmussen radiology score was 14 to 18 points, mean (17.0±1.5) points. X-ray examination showed no significant difference in TPA immediately after operation and 1.5, 3, 6, 12 months later (=0.05, =0.99), and there was no significant difference in PA among the time points (=0.02, =1.00). At one-year of follow-up, the modified Rasmussen knee score ranged from 18 to 29 with an average of (25.0±3.3) points, of which 7 were excellent, 8 were good and 1 was fair. The excellent and good rate was 93.75%. Knee range of motion was 110°-135° with a mean of (122±8)°. Lysholm score was 93±4. Evaluation of lateral stress test and dial test were both negative. The short-term curative effect of expanded anterolateral approach in treating fracture involved the posterolateral tibial plateau with the 3.5 mm proximal "L" type proximal tibial locking compression plate proximal to the locking screw is satisfactory, it provides sufficient exposure and effective fixation, the joint function and stability are satisfying.
探讨扩大前外侧入路治疗累及胫骨平台后外侧的骨折的短期疗效。回顾性分析2013年1月至2016年7月在皖南医学院第一附属医院接受扩大前外侧入路治疗累及胫骨平台后外侧骨折的16例患者的临床资料。患者采用3.5mm近端“L”型胫骨近端锁定加压钢板，通过钉排技术置入4枚锁定螺钉进行治疗。术后即刻及术后1.5、3、6和12个月进行X线检查，连续测量胫骨平台角（TPA）和后倾角（PA）。采用Rasmussen放射学评分评估骨折复位情况。1年后，采用改良Rasmussen膝关节评分评估膝关节功能恢复情况，采用Lysholm评分评估软骨损伤、软化及退变情况，并进行侧方应力试验和旋转试验评估膝关节稳定性。该组患者中男性11例，女性5例；年龄25～71岁，平均（47±12）岁；SchatzkerⅡ型9例，Ⅴ型6例，Ⅵ型1例。骨科创伤协会（OTA）分类中B型9例，C型7例。术后即刻行X线检查，显示14例解剖复位，2例台阶<2mm。Rasmussen放射学评分为14～18分，平均（17.0±1.5）分。X线检查显示术后即刻及术后1.5、3、6、12个月TPA差异无统计学意义（P=0.05，F=0.99），各时间点PA差异无统计学意义（P=0.02，F=1.00）。随访1年时，改良Rasmussen膝关节评分18～29分，平均（25.0±3.3）分，其中优7例，良8例，可1例。优良率为93.75%。膝关节活动范围为110°～135°，平均（122±8）°。Lysholm评分为93±4。侧方应力试验和旋转试验评估均为阴性。采用3.5mm近端“L”型胫骨近端锁定加压钢板近端锁定螺钉治疗累及胫骨平台后外侧的骨折，扩大前外侧入路的短期疗效满意，提供了充分的显露和有效的固定，关节功能及稳定性良好。
