[Clinical study on treatment of posterolateral fracture of tibial plateau via superior fibular head approach].

OBJECTIVE: To observe the effectiveness of the superior fibular head approach for the treatment of posterolateral fracture of the tibial plateau. METHODS: Between June 2010 and February 2012, 20 cases of posterolateral fracture of the tibial plateau were treated through superior fibular head approach, including 1 case of simple posterolateral fracture of the tibial plateau and 19 cases of posterolateral fracture of the tibial plateau with other fractures. There were 12 males and 8 females with an average age of 42.2 years (range, 28-58 years). All patients had closed fractures. Fracture was caused by traffic accident in 14 cases, by falling from height in 4 cases, and by twist injury in 2 cases. Associated injuries included lateral meniscus injury in 5 cases, medial meniscus injury in 2 cases, and anterior cruciate ligament injury in 1 case. The time from injury to admission ranged from 90 minutes to 32 hours (mean, 4.5 hours), and the time from admission to operation was 5-12 days (mean, 7.8 days). All cases underwent fracture reduction and fixation with Pilon plates through the superior fibular head approach, and associated fracture and meniscal injury were treated. RESULTS: All incisions healed by first intention, and no numbness or articular instability occurred. All patients were followed up 6-26 months (mean, 19.1 months). The average fracture healing time was 10.2 weeks (range, 8-12 weeks). During following-up, no related complication of fixation loosening or articular surface loss occurred. According to Rasmussen knee score criteria at last follow-up, the score was 18-30 (mean, 27.9); 16 cases were graded as excellent, 3 cases as good, and 1 case as fair, with an excellent and good rate of 95%. CONCLUSION: The superior fibular head approach for the treatment of posterolateral fracture of the tibial plateau is simple, safe, and effective, and can achieve a good surgical outcome.

[Surgical treatment of thoracolumbar burst fractures through Wiltse paraspinal approach].

OBJECTIVE: To investigate clinical effects and advantages of Wiltse paraspinal approach to thoracolumbar burst fractures. METHODS: From June 2008 to June 2010, the data of 53 patients with thoracolumbar burst fractures with no obviously nerve injury were retrospectively analyzed, including 43 males and 10 females with an average age of 41 years ( ranged, 19 to 62 years). For segmental distribution, 6 cases were T11, 11 cases were T12, 22 cases were L1 and 14 cases were L2. Among them, 28 cases were treated with Wiltse paraspinal approach, and 25 cases with postmiddle approach. The operation time, blood loss, postoperative drainage,VAS score of back, Cobb angle of injured cord, changes of collapse of vertebral and median sagittal diameter of injured vertebral were observed. RESULTS: Compared with two methods, there were advantages in improving operation time, blood loss, postoperative drainage and VAS score of back, but there were no significant differences in improving Cobb angle of injuried cord, changes of collapse of vertebral and median sagittal diameter of injuried vertebral. CONCLUSION: Wiltse paraspinal approach to thoracolumbar burst fractures can achieve the same reduction with postmiddle approach,and has advantages of minimally invasive, less blood, simple operation and rapid recovery, and worth popularizing.