探讨前外侧联合后内侧入路三柱重建胫骨平台三柱骨折的临床疗效。

回顾性分析2013年2月至2016年10月期间汕头市第二人民医院骨外科收治的胫骨平台骨折病例，对其中采用联合入路三柱固定的闭合性胫骨平台三柱骨折，并获完整随访的32例患者进行分析。采用配对t检验比较术后即刻和末次随访患肢胫骨平台内翻角（TPA）及后倾角（PA），评估内固定稳定性。记录末次随访美国特种外科医院（HSS）膝关节功能评分、骨折愈合情况及不良反应发生情况。

32例患者随访时间6~33个月，平均18.5个月。骨折愈合时间13~21周，平均16周，完全负重时间平均18周。术后即刻和末次随访患肢TPA［（86.2^°±4.4^°） vs （84.5^°±4.4^°）］及PA［（8.3^°±1.5^°）vs（9.2^°±1.6^°）］比较，差异均无统计学意义（t=1.58，P>0.05；t=-1.91，P>0.05）。末次随访患者膝关节活动度平均为2^°~121^°，HSS评分87~96分，平均93.5分。术后1例患者小腿后下部麻木，为腓肠内侧皮神经损伤所致，术后半年复查已恢复。患者切口均愈合良好，未出现重要血管损伤，无内固定松动、断裂等并发症发生。

复杂胫骨平台三柱骨折，采用前外侧联合后内侧入路行三柱固定，手术显露满意，固定可靠，可早期功能锻炼，术后疗效满意。

To assess the clinical effects of three-column reconstruction via the ranterolateral plus medial posterior approach in the treatment of three-column tibial plateau fractures.

The cases with tibial plateau fractures treated at our hospital from February 2013 to October 2016 were retrospectively reviewed. Thirty-two cases with closed three-column tibial plateau fractures who were treated by three-column fixation via the combined approach were included. These cases had complete clinical data, and there were 23 males and 9 females with an average age of 43.6 years. Tibial plateau-tibial shaft angle (TPA) and posterior angle (PA) were measured immediately after surgery and at the last follow-up for the affected limb. Stability of internal fixation was assessed. Hospital for special surgery knee score (HSS) was recorded at the last follow-up and functional recovery of the knee joint was assessed.

The 32 cases were followed for 6-33 months (average, 18.5 months). The time to bone fracture healing was 13-21 weeks with an average of 16 weeks, and the time to complete weight bearing was 18 weeks on average. There was no significant difference in TPA or PA immediately after surgery and at the last follow-up [(86.2^°±4.4^°) vs(84.5^°±4.4^°), t=1.58, P>0.05; (8.3^°±1.5^°) vs (9.2^°±1.6^°), t=-1.91, P>0.05]. The average knee joint range of motion was 2^°-121^° in the last follow-up, and HSS score was 87-96 (average, 93.5). One case had numbness in the posteroinferior part of the calf due to injury to the medial sural cutaneous nerve. This case recovered upon reexamination 6 months later. Incision healed well in all cases without injury to important vessels, loosening or fracture of internal fixation.

Three-column fixation via the anterolateral plus posteromedial approach for three-column tibial plateau fractures can achieve a good effect and stable fixation. The patients can start early functional training after surgery and the outcome is satisfactory.