改良Carlson入路治疗单纯胫骨后外侧平台骨折

Treatment of simple posterolateral tibial plateau fracture by modified Carlson approach

目的探讨改良Carlson入路治疗单纯胫骨后外侧平台骨折的疗效。方法回顾性分析2019年1月—2020年1月山东中医药大学附属医院创伤骨科收治的单纯胫骨后外侧平台骨折患者5例临床资料,男性3例,女性2例;年龄30~67岁,平均47.2岁;左侧3例,右侧2例;致伤原因摔伤1例,道路交通伤4例。采用改良Carlson入路治疗,纵行偏内侧直切口,缩小切口长度显露骨折。观察骨折愈合时间,采用美国特种外科医院(HSS)膝关节评分对末次随访膝关节功能进行评估,优>85分,良70~84分,中60~69分,差<59分。测量比较术后即刻与末次随访时的膝关节内翻角(TPA)及后倾角(PA),以及末次随访时膝关节活动度。结果5例患者均获得12~15个月定期门诊随访,平均13.6个月,无并发症发生;骨折均已骨性愈合,愈合时间11~14周,平均12.6周。术后12个月HSS评分80~93分,平均86.4分,优3例、良2例,优良率为100%;膝关节屈伸活动为123°~135°,平均129.0°;术后即刻与末次随访内翻角(TPA)、后倾角(PA)比较差异无统计学意义(P>0.05)。结论改良Carlson入路治疗单纯胫骨后外侧平台骨折能直接显露骨折,且创伤较小,术后功能恢复良好,值得临床推广。

Objective To investigate the efficacy of modified Carlson approach in the treatment of simple posterolateral plateau fracture of tibia.Methods Clinical data of 5 patients with simple posterolateral tibial plateau fracture admitted to The Department of Orthopaedics of Affiliated Hospital of Shandong University of Traditional Chinese Medicine from Jan.2019 to Jan.2020 were retrospectively analyzed,including 3 males and 2 females.Age ranged from 30 to 67 years,with an average of 47.2 years;3 cases were on the left and 2 cases on the right;the cause of injury:1 case of falling injury,4 cases of road traffic injury.The modified Carlson approach was used to narrow the incision length and expose the fracture.The fracture healing time was observed,and the American hospital for special surgery(HSS)score was used to evaluate knee joint function at the last follow-up.Excellent>85 points,good 70-84,fair 60 to 69,poor<59.The tibial plateau angle(TPA)and posterior angle(PA)immediately after operation and at the last follow-up,and knee joint activity at the last follow-up were measured and compared.Results All the 5 patients were followed up regularly for 12-15 months,with an average of 13.6 months.All the fractures had bone union,and the union time was 11-14 weeks,with an average of 12.6 weeks.The HSS score of 12 months after operation was 80-93,with an average of 86.4 points,excellent in 3 cases and good in 2 cases,and the excellent and good rate of HSS score was 100%.Knee flexion and extension activities ranged from 123°to 135°,with an average of 129.0°.There was no significant difference in TPA and PA between immediately after operation and at the last follow-up(P>0.05).Conclusion The modified Carlson approach for the treatment of simple posterolateral plateau fracture of tibia is effective and can directly expose the fracture,with little trauma and good postoperative function recovery,which is worthy of clinical promotion.