| Objective:As an intra-articular fracture,the posterolateral condyle fracture of the tibial plateau has a complex shape and is adjacent to important neurovascular bundles.The surgical approach and fixation method are controversial.In clinical treatment,posterolateral approach and posterolateral internal fixation are highly respected because they can well expose the posterolateral tibial plateau and can directly realize the support of the posterolateral plateau.However,the traditional anterolateral approach can also achieve good reduction of the posterolateral condyle fracture of the tibial plateau under the support of C Arm X-Ray Machine and arthroscopes.In this paper,by comparing the therapeutic effects of posterolateral internal fixation and anterolateral internal fixation in the treatment of fractures involving the posterolateral column of the tibial plateau,the purpose is to explore the reliability and therapeutic effect of anterolateral internal fixation in the treatment of this type of fracture,so as to provide information for the future treatment of such fractures.Methods:A total of 46 patients with posterolateral condyle fractures of the tibial plateau treated in the Department of Traumatology,the Fifth Affiliated Hospital of Guangzhou Medical University,Zengcheng People’s Hospital,and the Department of Traumatology,Sun Yat-sen Memorial Hospital of Sun Yat-sen University from January 2015 to October 2021 were included,including 29 males and 17 females,with an average age of 47.33 ± 14.78 years.The follow-up time was 6 months.According to the different surgical internal fixation methods,all the study cases were divided into two groups: according to whether posterolateral internal fixation was used or not,they were divided into the observation group(anterolateral internal fixation)and the control group(posterolateral internal fixation).SPSS 22.00 was used for statistical analysis of the data.For patients with fracture types,combined injuries,fracture morphology(cortical injury at the edge of the posterolateral platform,collapse of the articular surface of the posterolateral platform),and combined ligament injury around the joint,the statistics were used as count data.The chi-square test has ruled out general differences between the two groups.Age,tibial plateau varus angle,posterior slope angle,operation time,intraoperative blood loss,hospital stay,American Hospital for Special Surgery knee score,and Rasmussen imaging score were counted as measurement data,and the mean standard ± deviation((?) ± s)indicated.Independent samples t test was used to compare the two groups in terms of surgical effect and knee joint functional rehabilitation.Paired t test was used to compare the preoperative and postoperative curative effects of the two groups’ treatment effect.The test level α value was taken as 0.05 on both sides.If p < 0.05,the difference between the two was statistically significant.Results:There is no nerve damage,vascular damage,fracture displacement,deep wound infection and other complications occurred in the included patients.The average operation time of the control group was(312.22 ± 67.30)min,the average intraoperative blood loss was(190.00 ± 41.22)ml,and the average hospitalization time was(22.92 ± 12.84)days.In the observation group the average operation time was(175.08 ± 66.97)min,the average intraoperative blood loss was(140.83 ±30.73)ml,and the average hospitalization time was(22.68 ± 17.10)days.There was no significant difference in the amount of bleeding between the two groups(p >0.05),but there was a significant difference in the operation time between the two groups(p < 0.05).In the control group the average preoperative proximal tibia varus angle was(2.67 ± 5.28)°;the average postoperative proximal tibia varus angle was(1.83 ± 3.71)°;the mean preoperative posterior slope angle was(17.25 ± 6.72)°;the average postoperative posterior slope angle was(9.75 ± 4.00)°.In the observation group the average preoperative posterior slope angle was(16.47 ±4.07)°,the average postoperative posterior slope angle was(9.68 ± 4.28)°;the average preoperative proximal tibia varus angle was(2.71 ± 7.09)°;the average postoperative proximal tibia varus angle was(2.35 ± 5.35)°.There was no significant difference in the measured values of posterior slope angle and proximal tibia varus in two groups(p > 0.05).The measured values of posterior slope angle were significantly lower than those before operation(p < 0.05).There was no significant difference in the measured values of proximal tibia varus between the preoperative and postoperative comparison(p > 0.05).In the control group,the average preoperative Rasmussen imaging score was(6.17 ± 2.62),the average postoperative Rasmussen imaging score was(12.33 ± 2.67),the average postoperative score of HSS was(76.33 ± 13.84).In the observation group,the average preoperative Rasmussen imaging score(8.41 ± 2.99),the average postoperative Rasmussen imaging score(13.24 ± 1.91),the average postoperative score of HSS was(79.26 ± 11.09).There was no significant difference in score of HSS between the two groups(p > 0.05).There was no significant difference in postoperative Rasmussen imaging score between the two groups(p > 0.0 5).In the observation group,there was a statistically significant difference in Rasmussen imaging score between pre-operation and post-operation(p < 0.05).In the observation group,there was a statistically significant difference in Rasmussen imaging score between pre-operation and post-operation(p < 0.05).Conclusions:For patients with posterolateral tibial plateau fractures,either posterolateral internal fixation is an effective fixation method.There is no significant difference in anatomical reduction and knee function between two groups.The anterolateral internal fixation has the advantages of easy intraoperative operation,short operation time,less bleeding,and convenient removal of internal fixation after surgery.Therefore,anterolateral internal fixation is also a reliable option for the treatment of posterolateral condyle fractures of the tibial plateau. |
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