Department of Orthopedics, Affiliated Huishan Hospital of Xinglin College, Nantong University, Wuxi Huishan District People's Hospital, Wuxi, Jiangsu, China.
Sci Rep. 2024 May 22;14(1):11722. doi: 10.1038/s41598-024-62227-4.
The posterolateral tibial plateau fracture is a special type of intra-articular fracture, for which there is no simple, safe, and effective standardized procedure. In this paper, we evaluate the clinical efficacy and the advantages of the treatment of posterolateral tibial plateau fracture by using our designed proximal lateral tibial rim plate for the posterolateral condyle of the tibial plateau via the space above the fibula head. Thirty-eight patients with posterolateral tibial plateau fractures from June 2018 to June 2021 were retrospectively analyzed. CT scans were used to classify the degree of injury in the included patients. All of them were fixed with reduction using an approach above the fibula head combined with a homemade anatomical plate. The regular postoperative review was performed to instruct functional knee exercises. Postoperative complications were observed and follow-up visits were performed to assess the functional outcome. A total of 38 patients with posterolateral tibial plateau fractures, 13 males and 25 females were included in the study. All patients were followed up for 13-26 months, with a mean of 15.3 months. There were no postoperative complications such as numbness of the limb, knee joint instability, etc. X-ray review showed that the fractures were all healed, and the healing time was 10-16 weeks, with an average of 12.1 weeks; none of the internal fixation loosening and loss of articular surface occurred during the follow-up period. At the last follow-up, according to the HSS knee function score criteria, the scores were 79-98, with an average of 91.3. The HSS score presented excellent in 34 cases (89%) and good in 4 cases (11%). The Rasmussen score was graded as excellent in 29 cases (76%) and good in 9 cases (24%). In conclusion, The treatment of posterolateral tibial plateau fractures by an approach above the fibula head has the advantages of simplicity and safety, small trauma, and no risk of vascular and nerve injuries, and the anatomical proximal lateral tibial rim plate can play a direct and effective supporting role for the bone fragments of the posterolateral condyle, and the combination of both of them has obvious advantages in the treatment of posterolateral condylar fracture of the tibial plateau, and it is a method worth borrowing and popularizing.
胫骨平台后外侧骨折是一种特殊类型的关节内骨折，目前尚无简单、安全、有效的标准化治疗方法。本文通过腓骨头上方的空间，使用我们设计的胫骨近端外侧缘钢板治疗胫骨平台后外侧髁，评估该方法治疗胫骨平台后外侧骨折的临床疗效及优势。回顾性分析 2018 年 6 月至 2021 年 6 月收治的 38 例胫骨平台后外侧骨折患者，根据 CT 扫描对纳入患者的损伤程度进行分类。所有患者均采用腓骨头上方入路结合自制解剖钢板进行复位固定。术后定期复查，指导膝关节功能锻炼。观察术后并发症，随访评估功能结果。结果：共纳入胫骨平台后外侧骨折患者 38 例，男 13 例，女 25 例。所有患者均获得随访，随访时间 13-26 个月，平均 15.3 个月。术后无肢体麻木、膝关节不稳定等并发症。X 线片复查显示骨折均愈合，愈合时间为 10-16 周，平均 12.1 周；随访期间无内固定松动、关节面丢失。末次随访时，采用 HSS 膝关节功能评分标准评定，膝关节功能评分为 79-98 分，平均 91.3 分。HSS 评分优 34 例（89%），良 4 例（11%）。Rasmussen 评分优 29 例（76%），良 9 例（24%）。结论：腓骨头上方入路治疗胫骨平台后外侧骨折具有操作简单、安全、创伤小、不损伤血管和神经的优点，解剖型胫骨近端外侧缘钢板可对后外侧髁骨块起到直接有效的支撑作用，两者结合在治疗胫骨平台后外侧髁骨折中具有明显优势，是一种值得借鉴和推广的方法。
