Clinical Study Of Two Surgical Techniques Used To Treat Posteromedial Column Fracture In Tibial Plateau

Objective: Through observing and comparing two surgical techniques used in treatment of posteromedial column fracture in tibial plateau in clinical study, this paper aims to expand clinical therapeutic pathways, direct clinical work more effectively, reduce postoperative complications and improve the quality of life of postoperative patients.Mothods: Selecting 26 patients suffered from posteromedial column fracture in tibial plateau, who received surgical treatment in Department of Orthopedics of Longgang District Central Hospital of Shenzhen and Shenzhen Pingle Orthopedic Hospital from June 2012 to February 2015 were collected as research objects, retrospective analyses were made. According to two operative approaches, those patients were divided into two groups, the anteromedial approaches group(10 cases) and the posterior "inverted L" approaches group(16 cases). The former took the treatment of anteromedial approacheses while the latter took the posterior "inverted L " approaches. After operations, the limb was fixed with plaster slabs, and the patients were given functional exercise guidance and follow-ups for a period of 12 months to 14 months. Collecting and using statistical software SPSS17.0 to analyse data including age, postoperative fracture healing time, full weight-bearing time, range of knee motion in 12 months after the operation and HSS knee functional scores, we compared the clinical efficacy between the two groups.Results: The average age of patients in the posterior "inverted L" approaches group was 39.81 and the average age of patients in the anteromedial approaches group was 42.40, so age difference between the two groups was not statistically significant(P>0.05). In the posterior "inverted L" approaches group, fracture healing time were(14.43 ± 1.03) weeks, full weight-bearing time were(17.43 ± 1.59) weeks, while in the anteromedial approaches group, fracture healing time were(15.70 ± 1.49) weeks, full weight-bearing time were(20.20 ± 1.93) weeks, so the difference between the two groups was statistically significant(P <0.05). After operation(12 months), in the posterior "inverted L" approaches group, patient’s knee flexion was(131.00 ± 4.88) °and knee extension was(5.50 ± 1.82) °, while in the anteromedial approaches group, knee flexion was( 126.40 ± 3.43) ° and knee extension was(9.60 ± 2.27) °, so the difference between the two groups was statistically significant(P<0.05). In the posterior "inverted L" approaches group, the HSS knee functional scorewas(82.43±7.80) while in the anteromedial approaches group, the data was(72.50±6.99),so the difference between the two groups was statistically significant(P<0.05).Conclusion: Compared with anteromedial approaches, posterior "inverted L" approaches is more able to fully reveal the tibial plateau posterior column in operative treatment of posteromedial column fracture in tibial, possessing advantages of shorter fracture healing time,shorter full weight-bearing time, good postoperative knee function recovery effect which does not affect by age. Posterior "inverted L" approaches can meet the clinical needs of patients suffered from posteromedial column fracture in tibial plateau, so it is one of the preferred methods of treatment of posteromedial column fracture in tibial plateau.