| Objective: To study on the anatomy of the medial longitudinal small incision of the knee,to investigate the exposure and fixation methods of the posterior medial longitudinal small incision approach in the treatment of avulsion fracture,to sum up the advantages and disadvantages and the clinical application effect of the medial longitudinal small incision approach for the treatment of avulsion fracture and medial condylar fracture.Methods: 23 cases of posterior cruciate ligament tibial avulsion fractures and tibial plateau posteromedial condyle fractures patients in the subjects were all treated in HeBei Medical University Third Hospital period from September 2013-October 2015,12 cases were used the knee medial longitudinal form small incison,including 1 case tibial plateau posteromedial condyle fracture,11 cases were used the knee joint posterior“S”surgical approach,including 1 case tibial plateau posteromedial condyle fracture.Results: 1、The knee medial longitudinal form small incison group:The patients were prone,we cut along the medial border of the medial head of the gastrocnemius muscle in the knee crease,and enter the gap between the medial head of gastrocnemius musle and the semimembranosus,we expose the fracture block,and use the corresponding hollow nail 、rivet or plate to anatomically fix。The knee joint posterior“S”surgical approach group:The traditional “S”surgical approach is near-end begin the posterior margin of semitendinosus,up to knee joint plane,turn outside,along the bend marks across the popliteal fossa,finally turn to the far side,go later head of gastrocnemius musle surface up to 7~8cm,we cut popliteal fossa to expose gastrocnemius musle medial head,lateral head,medial sural cutaneous nerve and tibial nerve,expose popliteal artery and vein,we go into the gap of medial head and lateral head of gastrocnemius musle,expose tibial plateau posteromedial condyle and posterior cruciate ligament tibial avulsion fracture,we next fix the corresponding steel plate and the hollow screw.All patients were followed up after surgery,observed and recorded:Perioperative parameter:operation time,the bleeding of operation,posterior drawer test and posterior sag sign;postoperative follow up index:fracture healing,range of motion of knee joint,the Lysholm knee scoring scale and the international knee documentation committee knee scale.Applicating statistical software SPSS 13.0 to statistical analysis,measurement data were presented as mean ± standard deviation(± s),said the two groups were compared using the t test,enumeration date were compared using the chi-square test,and P <0.05 was considered statistically significant,there are differences between the two groups,comparing the advantages and disadvantages of the two surgical approach.Results: All patients were followed up except one patient was missing lost,the visit time is 9 to 18 months,an average of 13.5 months.All of the patients were followed up for bone healing,one patient of“S”surgical approach patients wound occured delay healing,after dressing change,the wound healing.No difference between the two groups of patients with posterior drawer test and posterior sag sign and fracture healing,The knee medial longitudinal form small incison group is obviously better than the knee joint posterior“S”surgical approach group in operation time,the bleeding of operation,range of motion of knee joint,the Lysholm knee scoring scale and the international knee documentation committee knee scale.Conclusion: The knee medial longitudinal form small incison can meet the operative procedure of posterior cruciate ligament tibial avulsion fracture and tibial plateau posteromedial condyle fracture,this approach is easy to operate,it is smally for the injury of peripheral vessels,small wound,small postoperative wound scar,little complication,knee joint function recovery effect is good,this approach is a good surgical approach,this approach is deserved to be popularized in clinical. |
