Clinical Observation of Internal and External Head Approach through Popliteal Gastrocnemius in the Treatment of Tibial Plateau Fractures Involving Posterior Column
LUO Xin-gang, GAO Chang-cheng
Department of Orthopedics, Baoji High-Tech Hospital, Baoji 721000
Abstract：【Objective】To investigate the clinical effect of popliteal gastrocnemius internal and external head approach in the treatment of elderly patients with tibial plateau fractures involving the posterior column. 【Methods】A total of 98 elderly patients with tibial plateau fractures involving the posterior column from January 2012 to January 2020 was randomly divided into observation group and control group, with 49 cases in each group. The observation group was treated by internal and external head approach through popliteal gastrocnemius muscle, and the control group was treated by standard anterolateral approach. The tibial plateau varus angle and caster angle were measured by imaging examination. 12 months after operation, the curative effect was evaluated by Rasmussen radiology score, and the knee function and stability were evaluated by New York Special Surgery Hospital scoring system (HSS). The therapeutic effects of the two groups were compared. 【Results】There was no significant difference in average operation time and average intraoperative bleeding between the two groups (P>0.05). The postoperative hospital stay and fracture healing time in the observation group were shorter than those in the control group (P<0.05); There was no significant difference in tibial plateau varus angle and retroversion angle between the two groups immediately after operation, 1 month, 3 months, 6 months and 12 months after operation (P>0.05). The Rasmussen score of the observation group was (15.72±2.26), and the excellent and good rate was 100%. The Rasmussen score of the control group was (14.05±1.98), and the excellent and good rate was 91.84% (45/49). The Rasmussen score and excellent and good rate of the observation group were higher than those of the control group (P<0.05). 12 months after operation, the HSS score and knee range of motion in the observation group were higher than those in the control group (P<0.05); In the observation group, only one patient developed infection one month after operation and returned to normal after treatment. In the control group, one patient had joint stiffness and relieved after targeted rehabilitation training.【Conclusion】The internal and external head approach through popliteal gastrocnemius muscle is a safe and reliable method for the treatment of elderly patients with tibial plateau fractures involving the posterior column. The postoperative fracture healing is good and the knee function returns to normal.
罗新刚, 高长城. 经腘窝腓肠肌内外侧头入路治疗累及后柱的老年胫骨平台骨折临床效果[J]. 医学临床研究, 2022, 39(1): 48-51.
LUO Xin-gang, GAO Chang-cheng. Clinical Observation of Internal and External Head Approach through Popliteal Gastrocnemius in the Treatment of Tibial Plateau Fractures Involving Posterior Column. JOURNAL OF CLINICAL RESEARCH, 2022, 39(1): 48-51.
[1] SHEN Q J, ZHANG J L, XING G S, et al. Surgical treatment of lateral tibial plateau fractures involving the posterolateral column[J].Orthop Surg,2019, 11(6):1029-1038. [2] FOSTER B, RODRIGUEZ-BUITRAGO A, OBREMSKEY W T. Prone posteromedial approach for posterior column tibial plateau fractures[J].J Orthop Trauma,2020, 2(5):S35-S36. [3] SELVARAJ V, DEVADOSS S, JAYAKUMAR S, et al. Column specific fixation for complex tibial plateau fractures-Midterm prospective study in South-Indian population[J].Injury,2020, 51(2):497-504. [4] CHO J W, KIM J, CHO W T, et al. Approaches and fixation of the posterolateral fracture fragment in tibial plateau fractures: a review with an emphasis on rim plating via modified anterolateral approach[J].Int Orthop,2017, 41(9):1887-1897. [5] QUINTENS L, VAN DEN BERG J, REUL M, et al. Poor sporting abilities after tibial plateau fractures involving the posterior column: how can we do better[J].Eur J Trauma Emerg Surg,2021, 47(1):201-209. [6] 赵祖发, 于利, 汤欣, 等. 切断腓肠肌内侧头的后内侧入路内固定治疗胫骨平台后柱骨折[J].中华创伤骨科杂志, 2018, 20(8):724-728. [7] 田伟, 王满宜. 骨折. 第2版[M]. 北京:人民卫生出版社, 2013:98-102. [8] 叶伟胜. 老年骨折防治手册[M]. 北京:人民军医出版社, 2013: 115-117. [9] VAN DEN BERG J, STRUELENS B, NIJS S, et al. Value of three-dimensional computed tomography reconstruction in the treatment of posterior tibial plateau fractures[J].Knee,2020, 27(1):3-8. [10] 赵耀伟, 谢加兵, 丁国正. 扩大前外侧入路治疗累及后外侧胫骨平台的骨折[J].中华医学杂志, 2018, 98(5):352-356. [11] SUN H, ZHU Y, HE Q F, et al. Reinforcement strategy for lateral rafting plate fixation in posterolateral column fractures of the tibial plateau: The magic screw technique[J].Injury,2017, 48(12):2814-2826. [12] TOULOUPAKIS G, GHIRARDELLI S, BIANCARDI E, et al. A remarkable pattern of a tibial plateau fracture-use of a safe technique with practical advantages in the surgical field[J].Acta Biomed,2019, 90(2):343-347. [13] DENG X, CHEN W, SHAO D, et al. Arthroscopic evaluation for tibial plateau fractures on the incidence and types of cruciate ligamentous injuries following closed reduction and internal fixation[J].Int Orthop,2020, 80(6):593-598. [14] ZHANG Y, SONG L, LI X, et al. Flexion-valgus unicondylar tibial plateau depression fracture pattern: Classification and treatment[J].Injury,2018, 49(4):852-859. [15] 李明, 郝秋彦, 曹相勋, 等. 传统前外侧入路关节镜辅助复位内固定治疗胫骨后外侧平台骨折的疗效分析[J].中华创伤骨科杂志, 2021, 23(11):975-981. [16] 姚俊娜, 王洪刚, 权松涛, 等. 后侧腘窝S形切口双窗口入路治疗胫骨平台后柱骨折[J].中国修复重建外科杂志, 2020, 34(5):39-43. [17] 许步伟. 后内侧入路双钢板内固定治疗胫骨后侧平台双柱骨折16例[J].江苏医药, 2016, 42(2):226-227. [18] TARNG Y W, LIN K C. A combined prone and supine approaches for complex three column tibial plateau fracture with posterolateral articular injury[J].Injury,2019, 50(10):1756-1763.
2022, Vol. 39 
