Abstract: Objective  To analyze the safety and effectiveness of combined anterior and posterior knee approach in the treatment of complex hyperextension tibial plateau fractures. Methods  92 patients with complex hyperextension tibial plateau fractures treated in the department of trauma and orthopedics of our hospital from February 2015 to February 2020 were analyzed retrospectively.The patients in the combined group received combined anterior and posterior knee approach (48 cases),and the patients in the central group received traditional anterior and median knee approach (44 cases).The perioperative conditions,follow-up indexes and imaging evaluation in 2 groups were recorded and compared.Results  The perioperative indicators such as intraoperative blood loss,radiation exposure time,postoperative drainage volume and hospital stay in the combined group were significantly lower than those in the median group (P＜0.05).At the last follow-up,the incidence of adverse reactions in the combined group was significantly lower than that in the median group (6.82% vs.13.16%,P＜0.05).At 3 months after operation and at the last follow-up,the hospital for special surgery (HSS) score of the knee joint [(64.57±0.47) vs.(56.39±0.46)] and Rasmussen score[(16.42±0.46) vs.(12.39±0.41)] in the combined group was safe than the median group(both P＜0.05).At the last follow-up,the improvement of tibial plateau imaging indexes such as varus angle[(84.16±4.89)° vs.(89.14±6.78)°],femoral tibial angle[(176.64±4.21)° vs.(167.65±3.83)°] and posterior dip angle[(11.54±0.79)° vs.(9.65±0.83)°] in the combination group was significantly lower than that in the median group (P<0.05). Conclusion The combined approach in the treatment of complex hyperextension tibial plateau fractures has satisfactory curative effect in restoring knee function,alleviating pain symptoms,promoting fracture healing,reducing perioperative indicators and avoiding the impact of surgical trauma on rehabilitation as much as possible.

Key words: tibial plateau fracture, reduction and internal fixation, surgical approach, hospital for special surgery, Rasmussen score