后侧手术入路、锁定钢板固定治疗胫骨平台后髁骨折的临床疗效

目的：探讨采用膝关节后内和后外侧切口、锁定钢板固定治疗胫骨平台后髁骨折的临床疗效。方法：选取2009年1月～2011年12月来我院治疗的13例胫骨平台后髁骨折患者作为研究对象，所有患者采用后内和后外侧切口、锁定钢板固定治疗，观察术后骨折愈合情况，采用Rasmussen放射学评分评定骨折复位情况，采用HSS评分系统评定膝关节功能疗效。结果：术后随访6～24个月，平均13．6个月，所有患者骨折均于16周内愈合。Rasmussen放射学评分15～18分，平均17．4分，其中优8例，良3例，可2例，优良率为84．7％。末次随访时膝关节功能HSS评分73~97分，平均91．4分，其中获优7例，良5例，可1例，优良率为92．3％。结论：采用膝关节后内和（或）后外侧切口、锁定钢板固定治疗胫骨平台后髁骨折具有操作简单、显露清晰、直视下复位骨折及关节面、固定牢靠、利于早期功能锻炼、临床疗效确切、并发症少等优点。

Clinical Effect of Posterior Surgical Approach with Locking Plate Fixation in the Treatment of Tibial Plateau Fractures

Objective： To investigate the clinical effect of open reduction and locking plate fixation through posterolateral or/and postcromedial approach of knee in the treatment of posterior condylar tibial plateau fractures. Methods： 13 patients with posterior condy- lar tibial plateau fractures in our hospital from January 2009 to December 2011 were selected as research subjects, all patients were fixed with locking plate via posterolateral or/and posteromedial incision. Results： All patients were followed up for 6-24 months （Average： 13.6 months）, and the fractures were all healed in 16 months. Rasmussen radiology score was 15 to18 points with an average of 17.4 points, including excellent in 8 cases, good in 3 cases, passable in 2 cases. The excellent and good rate was 84.7 %. Last follow-up knee HSS score was 73 to 97 points with an average of 91.4 points, including excellent in 7cases, good in 5 cases, passable in 1 case. The excellent and good rate was 92.3%. Conclusion： The Locking plate fixation with the posterolateral or/and posteromedial approach is beneficial for the treatment of posterior condylar tibial plateau fractures. It has many advantages, such as, less trauma, clearly exposure, stable internal fixation, early functional exercise, less complications and good therapeutic effects.