PDF(Pubmed)
Abstract：
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.
摘要：
胫骨平台后外侧骨折是一种特殊类型的关节内骨折,没有简单的，安全,和有效的标准化程序。在本文中,我们通过腓骨头上方的间隙，对我们设计的胫骨平台后外侧髁的胫骨近端外侧缘钢板治疗胫骨平台后外侧骨折的临床疗效和优势进行了评价。回顾性分析2018年6月至2021年6月38例胫骨平台后外侧骨折患者的临床资料。使用CT扫描对纳入患者的损伤程度进行分类。所有这些都使用腓骨头上方的方法结合自制的解剖板进行复位固定。定期进行术后复查以指导功能性膝关节锻炼。观察术后并发症并进行随访以评估功能结局。共38例胫骨平台后外侧骨折,该研究包括13名男性和25名女性。所有患者随访13～26个月,平均为15.3个月。术后无肢体麻木等并发症,膝关节不稳定,等。X线检查显示骨折全部愈合,愈合时间为10-16周，平均12.1周；随访期间内固定无松动和关节面丢失。在最后一次随访中，根据HSS膝关节功能评分标准，得分为79-98分,平均为91.3分.HSS评分优34例（89%），良4例（11%）。Rasmussen评分为优29例(76%),良9例(24%)。总之,腓骨头上方入路治疗胫骨平台后外侧骨折具有简便、安全等优点,小创伤,没有血管和神经损伤的风险，而解剖学上的胫骨近端外侧缘板对后外侧髁的骨碎片能起到直接有效的支撑作用,两者联合治疗胫骨平台后外侧髁突骨折具有明显优势,这是一种值得借鉴和推广的方法。
