Yang Shaozheng, Lian Yong, Yang Li, Ma Sushuang, Ding Chao, Huang Feng, Liu Yongqiang, Li Heng, Mutan Zhu, Zhong Hua, Chen Hongfen
Department of Orthopaedics, The Fifth Affiliated Hospital, Southern Medical University, Guangzhou, Guangdong, China.
Guangzhou University of Chinese Medicine, No. 261, Longxi Avenue, Liwan District, Guangzhou, Guangdong, China.
J Orthop Traumatol. 2025 Mar 19;26(1):19. doi: 10.1186/s10195-025-00836-z.
Various osteotomy techniques have been explored for exposing the posterolateral tibial plateau in previous studies. However, these methods are often complex, cause significant damage to normal anatomical structures, compromise knee joint stability, and pose risks to knee function, thus limiting their clinical application. This study proposes a new fibular head osteotomy technique for treating posterolateral tibial plateau fractures, aiming to achieve favorable surgical outcomes.
Thirteen patients who underwent surgical treatment for posterolateral tibial plateau fractures between March 2020 and August 2023 at our hospital were included in this study. The study was approved by the clinical ethics committee of our institution. All patients provided informed consent before participation. Surgeries were performed through a modified Frosch approach combined with partial fibular head osteotomy, while preserving part of the biceps femoris tendon attachment to the fibula. Postoperative fracture reduction quality was assessed using X-rays and computed tomography (CT) scans, in accordance with the Rasmussen radiology scoring system. Knee joint function was evaluated at the final follow-up using the Hospital for Special Surgery (HSS) scoring system. The healing of the fibular head osteotomy site and the presence of any complications were also assessed.
All 13 patients were followed up with for an average of 12.2 months (range: 9-17 months). All fractures, collapse, and deformities were corrected. The mean Rasmussen radiological score was 15.5 ± 2.5 (range: 10-18), with four cases rated as excellent, eight as good, and one as fair. The mean Hospital for Special Surgery (HSS) score was 89.8 ± 6.4 (range: 78-98), with 10 cases rated as excellent and 3 as good. No posterolateral knee instability was observed during physical examination at the final follow-up. There were no complications such as surgical site infection or common peroneal nerve injury.
Partial fibular head osteotomy combined with preservation of the biceps femoris tendon attachment is an effective technique for treating posterolateral tibial plateau fractures. This method allows for successful fracture reduction and fixation without compromising knee joint function.
在以往的研究中，已经探索了多种截骨技术来暴露胫骨后外侧平台。然而，这些方法通常较为复杂，会对正常解剖结构造成严重破坏，损害膝关节稳定性，并对膝关节功能构成风险，从而限制了它们的临床应用。本研究提出一种用于治疗胫骨后外侧平台骨折的新型腓骨头截骨技术，旨在获得良好的手术效果。
本研究纳入了2020年3月至2023年8月期间在我院接受手术治疗的13例胫骨后外侧平台骨折患者。本研究经我院临床伦理委员会批准。所有患者在参与前均签署了知情同意书。手术通过改良的Frosch入路结合部分腓骨头截骨进行，同时保留部分股二头肌肌腱在腓骨上的附着。术后根据Rasmussen放射学评分系统，使用X线和计算机断层扫描（CT）评估骨折复位质量。在末次随访时，使用特种外科医院（HSS）评分系统评估膝关节功能。还评估了腓骨头截骨部位的愈合情况及有无并发症。
13例患者平均随访12.2个月（范围：9 - 17个月）。所有骨折、塌陷及畸形均得到矫正。Rasmussen放射学评分平均为15.5±2.5（范围：10 - 18），其中4例为优，8例为良，1例为可。特种外科医院（HSS）评分平均为89.8±6.4（范围：78 - 98），其中10例为优，3例为良。末次随访体格检查时未观察到膝关节后外侧不稳定。未出现手术部位感染或腓总神经损伤等并发症。
部分腓骨头截骨联合保留股二头肌肌腱附着是治疗胫骨后外侧平台骨折的有效技术。该方法能够成功实现骨折复位与固定，且不损害膝关节功能。
