Pei Xuan, Wang Guodong, Qian Shenglong, Cheng Yipeng, Fang Zhixun, Ke Xi, Liu Ximing
Department of Orthopedics, General Hospital of Central Theater Command of Chinese PLA, Wuhan Hubei, 430070, P. R. China.
School of Medicine, Wuhan University of Science and Technology, Wuhan Hubei, 430081, P. R. China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2023 Apr 15;37(4):410-416. doi: 10.7507/1002-1892.202301019.
To investigate the effectiveness of osteotomy of non-core weight-bearing area of the lateral tibial plateau, reduction, and internal fixation in the treatment of tibial plateau fractures involving posterolateral column collapse.
A clinical data of 23 patients with tibial plateau fractures involving posterolateral column collapse, who had undergone osteotomy of non-core weight-bearing area of the lateral tibial plateau, reduction, and internal fixation between January 2015 and June 2021, was retrospectively analyzed. There were 14 males and 9 females with an average age of 42.6 years ranging from 26 to 62 years. The causes of injury included traffic accident in 16 cases, falling from height in 5 cases, and other injuries in 2 cases. According to Schatzker classification, there were 15 cases of type Ⅴ and 8 cases of type Ⅵ. The time from injury to operation was 4-8 days with an average of 5.9 days. The operation time, intraoperative blood loss, fracture healing time, and complications were recorded. The depth of articular surface collapse of posterolateral column and posterior inclination angle (PSA) of the tibial plateau were compared before operation and at 2 days and 6 months after operation; fracture reduction of tibial plateau fracture was evaluated by Rasmussen anatomic score. The recovery of knee function was evaluated by Hospital for Special Surgery (HSS) score at 2 days and 6 months after operation.
All 23 patients were completed the operation successfully. The operation time was 120-195 minutes, with an average of 152.8 minutes; the intraoperative blood loss was 50-175 mL, with an average of 109.5 mL. All patients were followed up 12-24 months, with an average of 16.7 months. One patient had superficial wound infection after operation, and the incision healed after dressing change; primary healing of incision of other patients was obtained. The fracture healing time was 12-18 weeks, with an average of 13.7 weeks. No failure of internal fixation, varus and valgus deformity of the knee joint, and instability of the knee joint was found at last follow-up. One patient developed joint stiffness and the range of motion of the knee joint was 10°-100°; the range of motion of the knee joint of other patients was 0°-125°. At 2 days and 6 months after operation, the depth of articular surface collapse of posterolateral column, PSA, and Rasmussen anatomic scores significantly improved when compared with those before operation ( <0.05). There was no significant difference between the two postoperative time points ( 0.05). The HSS score at 6 months after operation was significantly higher than that at 2 days after operation ( <0.05).
For tibial plateau fractures involving posterolateral column collapse, reduction and internal fixation through osteotomy of non-core weight-bearing area of the lateral tibial plateau has the advantages of fully expose the posterolateral column fragment, good articular surface reduction, sufficient bone grafting, and fewer postoperative complications. It is beneficial to restore knee joint function and can be widely used in clinic.
探讨胫骨外侧平台非负重核心区截骨、复位及内固定治疗累及后外侧柱塌陷的胫骨平台骨折的疗效。
回顾性分析2015年1月至2021年6月期间23例接受胫骨外侧平台非负重核心区截骨、复位及内固定治疗的累及后外侧柱塌陷的胫骨平台骨折患者的临床资料。其中男性14例，女性9例，平均年龄42.6岁，年龄范围26至62岁。受伤原因包括交通事故16例，高处坠落5例，其他损伤2例。根据Schatzker分型，Ⅴ型15例，Ⅵ型8例。受伤至手术时间为4至8天，平均5.9天。记录手术时间、术中出血量、骨折愈合时间及并发症情况。比较术前、术后2天及术后6个月时后外侧柱关节面塌陷深度及胫骨平台后倾角（PSA）；采用Rasmussen解剖评分评估胫骨平台骨折的复位情况。采用美国特种外科医院（HSS）评分在术后2天及术后6个月评估膝关节功能恢复情况。
23例患者均成功完成手术。手术时间为120至195分钟，平均152.8分钟；术中出血量为50至175毫升，平均109.5毫升。所有患者均随访12至24个月，平均16.7个月。1例患者术后出现浅表伤口感染，经换药后切口愈合；其他患者切口均一期愈合。骨折愈合时间为12至18周，平均13.7周。末次随访时未发现内固定失败、膝关节内外翻畸形及膝关节不稳情况。1例患者出现关节僵硬，膝关节活动范围为10°至100°；其他患者膝关节活动范围为0°至125°。术后2天及术后6个月时后外侧柱关节面塌陷深度、PSA及Rasmussen解剖评分与术前比较均显著改善（P<0.05）。术后两个时间点比较差异无统计学意义（P>0.05）。术后6个月时HSS评分显著高于术后2天时（P<0.05）。
对于累及后外侧柱塌陷的胫骨平台骨折，经胫骨外侧平台非负重核心区截骨进行复位及内固定具有充分暴露后外侧柱骨折块、关节面复位良好、植骨充分及术后并发症少等优点，有利于恢复膝关节功能，可在临床广泛应用。
