延长腓骨头上双间隙入路切开复位内固定治疗累及后外侧柱胫骨平台骨折19例  

An extended double-space approach for internal fixation of posterolateral column tibial plateau fractures in 19 cases

作　　者：杨秀 陈翰霖 王鸿燊 陈庆泉 王万明 陈金水 YANG Xiu;CHEN Hanlin;WANG Hongshen;CHEN Qingquan;WANG Wanming;CHEN Jinshui(Fuzong Clinical Medical College of Fujian Medical University(the 90Oth Hospital),Fuzhou,Fujian 350000,China)

机构地区：[1]福建医科大学福总临床医学院(第九○○医院),福建福州350000

出　　处：《中国骨与关节损伤杂志》2024年第4期371-374,共4页Chinese Journal of Bone and Joint Injury

基　　金：联勤保障部队第九○○医院院内课题(2021JQ06)。

摘　　要：目的评估延长腓骨头上双间隙入路内固定治疗累及后外侧柱胫骨平台骨折的可行性并观察术后短期疗效。方法回顾性分析自2018-09—2022-09采用手术治疗的19例累及后外侧柱胫骨平台骨折,7例为单纯后外侧柱骨折,12例为外侧柱合并后外侧柱骨折,均出现后壁破裂。经延长腓骨头上双间隙入路切开复位骨折后采用2块钛板固定,前外侧选用3.5 mm外侧平台L形解剖钛板固定,将前外侧解剖钛板尽可能地放置在外侧平台靠后的位置,后侧钛板置于腓总神经与腓肠肌外侧头间隙。结果19例均获得随访,随访时间11~18个月,平均15.7个月。术中未出现血管、神经损伤,术后未出现切口感染,出院时骨折复位Rasmussen放射学评分为14~18分,平均16.7分。随访期间未出现关节面再次塌陷、内固定失效、骨折再次移位、切口深部感染、骨折不愈合等并发症。骨折愈合时间8~14个月,平均10.7个月。末次随访时膝关节功能HSS评分为92.1~96.4分,平均94.2分;膝关节活动度为110°~126°,平均118.2°。结论延长腓骨头上双间隙入路切开复位内固定手术适用于治疗累及后外侧柱的胫骨平台骨折,在一个切口下完成前外侧和后外侧双钢钛板内固定,不必进行腓骨头截骨;双钛板内固定的生物力学稳定性好,术后患者可相对较早进行膝关节轴向负重,术后关节面再次塌陷风险低。Objective To assess the feasibility of utilizing an extended double-space approach for internal fixation of the fibula head in treatment of posterolateral column tibial plateau fractures and evaluate its short-term postoperative outcomes.Methods A retrospective analysis was conducted on 19 cases of tibial plateau fractures involving posterolateral columns that underwent surgical treatment from September 2018 to September 2022.Seven cases were simple posterolateral column fractures while twelve involved combined lateral column fractures with posterior wall rupture.The fracture reduction was achieved through an extended double-space approach on the head of the fibula,followed by fixation using two titanium plates.An anatomically shaped L-shaped titanium plate measuring 3.5 mm was utilized for fixing the anterolateral platform.The placement of the anterolateral anatomical titanium plate maximized its position on the lateral platform,while the posterior titanium plate was positioned within the space between the lateral head of the common peroneal nerve and gastrocnemius muscle.Results Nineteen patients were followed up for 11 to 18 months,with an average of 15.7 months.No vascular or nerve injuries occurred in operation,and there were no postoperative incision infections.The Rasmussen radiological score for fracture reduction at discharge ranged from 14 to 18,with an average score of 16.7.Throughout the follow-up period,no complications such as joint surface collapse,internal fixation failure,fracture displacement recurrence,deep incision infection or nonunion were reported.Fracture healing time ranged from 8 to 14 months(mean 10.7 months).At the final follow-up assessment,knee joint function measured by HSS score was between 92.1 and 96.4 points(mean 94.2),while the range of motion of the knee joint were from 110°to 126°(average 118.2°).Conclusion The extended double-space approach internal fixation is a suitable treatment for tibial plateau fractures involving posterolateral columns.Anterolateral and posterolate

关 键 词：胫骨平台骨折 后外侧柱 腓骨头上方 双间隙入路 内固定 

分 类 号：R687.3[医药卫生—骨科学]