改良Carlson入路在累及后外侧柱胫骨平台骨折手术治疗中的应用

Application of modified Carlson approach in the treatment of tibial plateau fractures involving posterolateral column

目的探讨改良Carlson入路治疗累及后外侧柱胫骨平台骨折中的临床疗效。方法回顾性分析2017年1月—2019年1月南京中医药大学附属昆山市中医医院关节骨科收治的累及后外侧柱胫骨平台骨折患者37例,男性21例,女性16例;年龄33~77岁,平均50.2岁。道路交通伤19例,骑车摔伤11例,高处坠落伤7例。Schatzker分型:Ⅱ型19例,Ⅲ型7例,Ⅴ型11例。根据罗从风三柱分型:单纯后外侧柱骨折16例,后外侧柱合并外侧柱骨折10例,后外侧柱合并后内侧柱骨折3例,累及后外侧的三柱骨折8例。均采用改良Carlson入路结合T形锁定钢板内固定后外侧柱。术后定期随访,根据胫骨平台内翻角、后倾角及Rasmussen放射评分评价复位质量;特种外科医院(HSS)评分评价膝关节功能;Lachmann试验及轴移试验评价膝关节稳定性。结果患者均获随访12~18个月,平均13.2个月。术后即刻、3、6和12个月的平台内翻角及后倾角比较差异均无统计学意义(P>0.05)。末次随访时Rasmussen放射评分优7例,良26例,可4例,优良率89%。HSS评分优27例,良8例,可2例,优良率95%。膝关节活动度(ROM):100°~135°,平均128.5°。Lachmann试验及轴移试验均为阴性。结论改良Carlson入路治疗累及后外侧柱胫骨平台骨折手术安全有效,术后恢复快,膝关节功能良好,值得临床推广应用。

Objective To investigate the clinical effect of modified Carlson approach in the treatment of tibial plateau fractures involving posterolateral column.Methods Totally 37 patients with tibial plateau fractures involving the posterolateral column treated in Department of Orthopaedics,Kunshan Hospital of Traditional Chinese Medicine from Jan.2017 to Jan.2019 were retrospectively analyzed,including 21 males and 16 females,with an average of 50.2 years(range,33-77 years).Causes of injury:19 cases of road traffic injury,11 cases of bicycle falling injury and 7 cases of falling injury.According to Schatzker classification,there were 19 cases of type II,7 cases of type III and 11 cases of type V.According to Luo’s three column classification:16 cases of simple posterolateral column fracture,10 cases of posterolateral column combined with lateral column fracture,3 cases of posterolateral column combined with posteromedial column fracture,and 8 cases of posterolateral three column fracture.The modified Carlson approach combined with T-shaped locking plate internal fixation was used in the treatment of posterolateral column.The reduction quality was evaluated according to tibial plateau varus angle,retroversion angle and Rasmussen radiation score;Hospital for special surgery(HSS)score was used to evaluate knee function;Lachmann test and axial displacement test were used to evaluate the stability of knee joint.Results All patients were followed up for 12 to 18 months,with an average of 13.2 months.There was no significant difference in plat form varus angle and caster angle between the two groups immediately,3,6 and 12 months after operation(P>0.05).At the last follow-up,Rasmussen radiation score was excellent in 7 cases,good in 26 cases,fair in 4 cases,and the excellent and good rate was 89%.HSS score was excellent in 27 cases,good in 8 cases,fair in 2 cases,and the excellent and good rate was 95%.The range of motion(ROM)ranged from 100°to 135°with an average of 128.5°.Lachmann test and axial shift test were negative.Conclusion The improved Carlson approach is safe and effective in the treatment of tibial plateau fractures involving the posterolateral column,with rapid postoperative recovery and good knee function,which is worthy of clinical application.