Yangzhou Jiangdu People's Hospital, 9 Dongfanghong Road, Jiangdu District, Yangzhou City, Jiangsu Province, China.
Affiliated Hospital of Yangzhou University, 45 Taizhou Road, Guangling District, Yangzhou City, Jiangsu Province, China.
Medicine (Baltimore). 2021 Sep 24;100(38):e27316. doi: 10.1097/MD.0000000000027316.
To summarize the surgical technique and clinical effects of the extended anterolateral approach for the treatment of Schatzker type II and Schatzker type V/VI involving the posterolateral column tibial plateau.From January 2015 through December 2018, 28 patients with tibial plateau fractures involving the posterolateral column were included in the study. Among them, 16 patients were Schatzker type II treated using an extended anterolateral approach with lateral tibial locking compression plate fixation. Twelve patients were Schatzker type V or VI treated using an extended anterolateral combined with a medial approach using lateral tibial locking compression plate plus medial locking compression plate fixation. All cases were followed up for 15 to 31 months, with an average follow-up of 22.5 ± 3.7 months. During the follow-up, the tibial plateau angle (TPA), lateral posterior angle (PA) and Rasmussen radiological criteria were used to evaluate the effect of fracture reduction and fixation; the Hospital for Special Knee Surgery score and the range of motion were used to evaluate knee function. Additionally, the Lachman and knee Valgus (Varus) stress tests were used to evaluate anteroposterior and lateral stability of the knee.All fractures healed. At the 12-month follow-up, the Schatzker type II group revealed a mean TPA of 86.38 ± 3.92°, a mean PA of 7.43 ± 2.68°, and a mean Rasmussen radiological score of 16.00 ± 2.06 points. The Schatzker type V/VI group showed a mean TPA of 84.91 ± 3.51°, a mean PA of 9.68 ± 4.01°, and a mean Rasmussen radiological score of 15.33 ± 2.99 points. During the 1-year follow-up, when the postoperative PA was re-measured, the TPA and Rasmussen score of the 2 groups did not change significantly (P > .05). At the last follow-up, the Schatzker type II group showed a knee flexion angle of 110° to 135° and a mean HHS score of 88.37 ± 10.01 points. The Schatzker type V/VI group revealed a knee flexion angle of 100° to 130° and a mean HHS score of 82.17 ± 10.76 points. Additionally, up to the last follow-up, the Lachman and knee Valgus (Varus) stress test results of the 2 groups were negative. No complications were found.The extended anterolateral approach is a good choice to treat tibial plateau fractures involving the posterolateral column.
总结采用改良前外侧入路治疗涉及后外侧柱胫骨平台骨折的 Schatzker Ⅱ型和Ⅴ/Ⅵ型的手术技术和临床效果。2015 年 1 月至 2018 年 12 月，研究纳入 28 例涉及后外侧柱的胫骨平台骨折患者。其中，采用改良前外侧入路加外侧胫骨锁定加压钢板固定治疗 Schatzker Ⅱ型 16 例，采用改良前外侧联合内侧入路加外侧胫骨锁定加压钢板加内侧锁定加压钢板固定治疗 Schatzker Ⅴ或Ⅵ型 12 例。所有病例均获得 15 ～ 31 个月（平均 22.5±3.7 个月）随访。随访期间，采用胫骨平台角（TPA）、外侧后角（PA）和 Rasmussen 影像学标准评估骨折复位和固定效果；采用膝关节特殊外科医院（HSS）评分和膝关节活动度评估膝关节功能。另外，采用 Lachman 和膝关节内翻（外翻）应力试验评估膝关节前后和外侧稳定性。所有骨折均愈合。12 个月随访时，Schatzker Ⅱ型组 TPA 平均为 86.38°±3.92°，PA 平均为 7.43°±2.68°，Rasmussen 影像学评分平均为 16.00°±2.06 分；Schatzker Ⅴ/Ⅵ型组 TPA 平均为 84.91°±3.51°，PA 平均为 9.68°±4.01°，Rasmussen 影像学评分平均为 15.33°±2.99 分。术后 1 年复查时，两组患者的 TPA 和 Rasmussen 评分与术后即刻相比均无明显变化（P>.05）。末次随访时，Schatzker Ⅱ型组膝关节屈曲角度为 110°～ 135°，HSS 评分平均为 88.37°±10.01 分；Schatzker Ⅴ/Ⅵ型组膝关节屈曲角度为 100°～ 130°，HSS 评分平均为 82.17°±10.76 分。另外，末次随访时，两组 Lachman 和膝关节内翻（外翻）应力试验结果均为阴性。未发现并发症。采用改良前外侧入路治疗涉及后外侧柱胫骨平台骨折是一种较好的选择。
