经腓骨头上入路手术治疗单纯后外侧胫骨平台骨折疗效观察  

Effect of supra-fibular head approach surgery in treatment of simple posterolateral fractures of tibial plateau

作　　者：方添顺 梁星星 吴猛[1] 李建有[1] 李雄峰[1] FANG Tian-shun;LIANG Xing-xing;WU Meng;LI Jian-you;LI Xiong-feng(Department of Orthopedics,Huzhou Central Hospital,Huzhou,Zhejiang 313000,China)

机构地区：[1]湖州市中心医院(浙江大学湖州医院)骨科,浙江313000

出　　处：《中国骨与关节损伤杂志》2021年第2期135-138,共4页Chinese Journal of Bone and Joint Injury

基　　金：浙江省自然科学基金(LY15E020001)。

摘　　要：目的探讨经腓骨头上入路手术治疗单纯后外侧胫骨平台骨折的安全性与有效性。方法回顾性分析自2016-01—2019-10采用腓骨头上入路切开复位内固定治疗的34例单纯后外侧胫骨平台骨折。经腓骨头上入路的切口起自于Gerdy’s结节,向上向后经过腓骨头上缘2 cm处作一个直切口。胫骨平台高度及关节面高度恢复后,取塑形好的L形锁定钢板头部倒置于腓骨头上,位置尽量靠后,在横臂靠后处钻孔置入1枚螺钉固定,钢板长臂置于胫骨平台后外侧,置入螺钉固定。结果 34例均获得随访,随访时间6~24(13.5±6.5)个月。术后骨折愈合时间为(13.7±2.3)周,完全负重时间为(14.9±2.4)周。末次随访时膝关节屈伸活动度为(105.6±20.7)°。末次随访时膝关节功能HSS评分为(88.9±7.2)分,其中优22例,良10例,可2例,优良率94.1%。结论经腓骨头上入路手术治疗单纯后外侧胫骨平台骨折操作简便、安全,不容易损伤膝关节重要血管神经,不破坏膝关节周围骨性结构与韧带,有利于术后膝关节功能恢复。ObjectiveTo observe the safety and effectiveness of the supra-fibular head approach surgery in the treatment of simple posterolateral fractures of the tibial plateau.MethodsThirty-four cases of simple posterolateral fractures of the tibial plateau were treated with the supra-fibular head approach surgery from January 2016 to October 2019.All patients underwent fracture reduction and internal fixation with locking plates via the supra-fibular head approach.The incision of the superior fibular head approach started from Gerdy’s tubercle and reached approximately 2 cm above the fibular head.After reconstructing the articular height of the posterolateral tibial plateau,the short arm of the L-shaped locking plate was placed above the head of the fibula,and then the long arm of locking plate was placed on the posterolateral tibial plateau as rear as possible.Finally,the plate was fixed with screws.ResultsAll patients were followed up for 6-24 months(mean,13.5±6.5 months).The average fracture healing time was(13.7±2.3)weeks.The knee movement angle at the last follow-up was(105.6±20.7)°.According to HSS knee score criteria at last follow-up,the score was(88.9±7.2),and 22 cases were graded as excellent,10 cases as good,and 2 cases as fair,with an excellent and good rate of 94.1%.ConclusionThe supra-fibular head approach surgery for the treatment of posterolateral fractures of the tibial plateau is relatively simple and safe.The operation is unlikely to damage important blood vessel and nerves around the knee joint,and do not damage the bony structures and ligaments around the knee joint.It is beneficial to the functional recovery of knee joint after operation.

关 键 词：后外侧胫骨平台骨折 腓骨头上入路 锁定钢板 内固定 

分 类 号：R687.3[医药卫生—骨科学]