Jiang Liangjun, Zheng Qiang, Pan Zhijun
The Orthopedics Department of 2nd Affiliated Hospital of Medical, College of Zhejiang University, The Jiefang road 88#, Hangzhou, Zhejiang, China.
J Orthop Surg Res. 2018 Nov 28;13(1):303. doi: 10.1186/s13018-018-1007-7.
Our hospital has recently used the extended anterolateral approach in posterolateral tibial plateau fracture. We compared the clinical effects of this method in Schatzker type II or type V/VI fractures with posterolateral tibial plateau fracture based on our patients.
The patients from January 2013 to December 2015 were summarized, and some of them were assisted with arthroscopy. According to Schatzker classification, patients with Schatzker type II fracture were divided into group A; patients with Schatzker type V/VI fracture were divided into group B. The fracture characteristics, operation statistics, and postoperative functional evaluation of each group were compared.
A total of 46 patients were included in the study and were followed up for 23-45 months. There were 24 cases in group A and 22 cases in group B. The operation time and the amount of bleeding were significantly less in group A (P < 0.05). Twelve cases were assisted with arthroscopy including 6 patients in each group. The fracture healing time made no significant difference in the two groups (P > 0.05). All patients experienced no significant influence on daily life. The knee Rasmussen score was 26.8 in group A and 23.5 in group B (P > 0.05), and the knee range motion was 115.5° in group A and 106.6° in group B (P > 0.05). The excellent and good rate of reduction was 91.7% in group A and 81.8% in group B (P > 0.05), but the excellent rate of reduction was 83.3% in group A and 27.3% in group B (P < 0.05). The unfixed rate of posterolateral fracture was 16.7% in group A and 36.4% in group B (P > 0.05). One patient in group B suffered postoperative wound infection.
The extended anterolateral approach could obtain similar satisfactory clinical results in simple/complex tibial plateau fracture with posterolateral tibial plateau fracture. It seemed that easier operation, better posterolateral fracture reduction, and fixation occurred in relative simple fracture from our cases.
It was a retrospective study. This study was consistent with the ethical standards of the Second Affiliated Hospital of Zhejiang University Medical College and was approved by the hospital ethics committee and the trial registration number of our hospital was 20170053.
我院近期在胫骨平台后外侧骨折中采用了扩大前外侧入路。我们基于患者情况比较了该方法在Schatzker II型或V/VI型骨折合并胫骨平台后外侧骨折中的临床效果。
总结2013年1月至2015年12月期间的患者，部分患者辅助关节镜检查。根据Schatzker分型，将Schatzker II型骨折患者分为A组；将Schatzker V/VI型骨折患者分为B组。比较每组的骨折特征、手术统计数据及术后功能评估。
本研究共纳入46例患者，随访23 - 45个月。A组24例，B组22例。A组手术时间和出血量明显更少（P < 0.05）。12例患者辅助关节镜检查，每组各6例。两组骨折愈合时间无显著差异（P > 0.05）。所有患者日常生活均未受明显影响。A组膝关节Rasmussen评分为26.8分，B组为23.5分（P > 0.05），A组膝关节活动范围为115.5°，B组为106.6°（P > 0.05）。A组复位优良率为91.7%，B组为81.8%（P > 0.05），但A组复位优率为83.3%，B组为27.3%（P < 0.05）。A组后外侧骨折未固定率为16.7%，B组为36.4%（P > 0.05）。B组有1例患者术后伤口感染。
扩大前外侧入路在合并胫骨平台后外侧骨折的简单/复杂胫骨平台骨折中可获得相似的满意临床效果。从我们的病例来看，相对简单的骨折手术操作似乎更简便，后外侧骨折复位及固定效果更好。
这是一项回顾性研究。本研究符合浙江大学医学院附属第二医院的伦理标准，并获得医院伦理委员会批准，我院试验注册号为20170053。
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