目的:探讨改良Frosch入路在累及后外侧柱的Schatzker Ⅱ型胫骨平台骨折中的临床疗效。方法:自2019年1月至2020年9月，共收治累及后外侧柱的Schatzker Ⅱ型胫骨平台骨折患者11例，男7例，女4例，年龄21～49岁，采用侧卧位改良Frosch入路，后外侧骨折块采用支撑钢板或由后向前螺钉固定，前外侧采用常规胫骨平台外侧锁定钢板固定。X线测量术后即刻及术后12个月时胫骨平台内翻角和后倾角，及术后12个月膝关节活动度，采用美国特种外科医院(Hospital for Specdial Surgery，HSS)膝关节评分评价术后12个月时膝关节功能恢复情况。结果:11例患者获得随访，时间12～15个月。术后即刻内翻角、后倾角分别为76°～86°、6°～10°，术后12个月分别为79°～88°、6°～10°。术后12个月膝关节活动度，伸0°～5°，屈曲106°～137°。术后12个月HSS膝关节评分为74～94分，优8例，良3例。结论:经改良Frosch入路在累及后外侧柱的Schatzker Ⅱ型胫骨平台骨折是一种有效的手术方法，单一切口完成2个部位骨折显露固定，避免采用联合切口，可获得良好的术后膝关节功能。术中应熟悉掌握胭窝结构，注意保护腓总神经，避免损伤。
Application of modified Frosch approach for Schatzker type Ⅱ tibial plateau fractures with posterolateral column
Objective To explore clnical efficacy of modified Frosch approach for Schatzker type Ⅱ tibial plateau fracture with posterolateral column.Methods From January 2019 to September 2020,totally 11 patients with Schatzker type Ⅱ tibial plateau fractures with posterolateral column were treated,including 7 males and 4 females,aged from 21 to 49 years old.Modi-fied Frosch approach was adopted for lateral decubitus position,and posterolateral fractures were fixed with support plates or posterolateral screws.Anterolateral fixation with conventional tibial plateau lateral locking plate.Tibial plateau varus angle and posterior inclination angle were measured by X-ray immediately and 12 months after operation,as well as knee motion at 12 months after operation.Knee function at 12 months after operation was evaluated by knee score of Hospital for Special Surgery(HSS).Results Eleven patients were followed up for 12 to 15 months.Varus angle and inclination angle at immediately after operation ranged from 76° to 86° and 6° to 10°,respectively,and 79° to 88° and 6° to 10°,respectively at 12 months after op-eration.The range of extension of knee ranged from 0° to 5°,and flexion was 106° to 137° at 12 months after operation.Post-operative HSS knee score at 12 months ranged from 74 to 94 scores,8 patients were excellent and 3 good.Conclusion Modi-fied Frosch approach is an effective surgical method for Schatzker type Ⅱ tibial plateau fracture with posterolateral column.A single incision is used to complete fracture exposure and fixation at two sites,avoiding use of combined incisions,and could ob-tain good postoperative knee joint function.During operation,popliteal fossa structure should be familiar,and the common per-oneal nerve should be protected to avoid injury.
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