改良Carlson入路切开复位F4钢板内固定治疗胫骨平台后外侧盲区骨折

Modified Carlson approach combined with F4 plate internal fixation for treatment of posterolateral tibial plateau fractures

目的 观察改良Carlson入路切开复位F4钢板内固定治疗胫骨平台后外侧盲区骨折的临床疗效。方法 回顾性分析自2015-08—2017-07采用改良Carlson入路切开复位F4钢板内固定治疗的17例胫骨平台后外侧盲区骨折,采用纵向直形切口,切口位于腓骨头内侧缘内1 cm处,起自腘窝关节线上3 cm并直接向下延伸8~10 cm,通过改良Carlson入路显露骨折端并复位骨块,同时根据骨折线的长度和位置对F4钢板进行裁剪后固定骨折。结果 17例均获得随访,随访时间12~34个月,平均18.5个月。16例术后3个月骨折愈合,1例术后6个月骨折愈合。未出现血管和神经损伤,以及伤口感染、开裂等并发症。末次随访时未发现骨折不愈合、畸形愈合、复位丢失,以及膝关节不稳或因比目鱼肌止点部分剥离而出现足趾屈曲无力等情况。末次随访时膝关节伸直-屈曲活动范围105°~135°,平均122°;膝关节KSS评分78~100分,平均89.2分;短期肌肉骨骼功能SMFA评分8~33分,平均18.7分。结论 改良Carlson入路切开复位F4钢板内固定治疗胫骨平台后外侧盲区骨折安全有效,可以直视骨折端进行有效复位,固定更为可靠,临床疗效满意。

Objective To evaluate the clinical outcomes of the modified Carlson approach combined with a self-tailoring F4 plate for patients with posterolateral“blind zone”tibial plateau fractures.Methods Seventeen patients with posterolateral tibial plateau fractures from August 2015 to July 2017 were included.The posterolateral“blind zone”fractures were reduced and fixed using the modified Carlson approach.Using a longitudinal straight incision,the incision is located 1 cm inside the medial edge of the fibular head,and starting at 3 cm from the popliteal fossa joint line and extending directly downwards for 8-10 cm.The fracture was exposed through an improved Carlson approach and reduced.At the same time,the F4 steel plate was cut according to the length and position of the fracture line to fix the fracture.Results All the 17 cases were followed up for 12-34 months.The mean follow-up time was 18.5 months.16 cases had bone union 3 months after surgery,and 1 case had fracture healing 6 months after surgery.No second collapse was detected and all patients had a stable knee joint after surgery by the modified Carlson approach.No complications including vascular and nerve injuries occurred.The average range of knee was 123°,two patients had 5° deficiency in full extension.At the last follow-up,the average SMFA dysfunction score was 18.7 and the average KSS score was 89.2.Conclusion The modified Carlson approach could provide direct visualization to reduce the fractures.A self-tailoring F4 plate can be designed according to the fracture line for effective fixation.This is an effective and safe surgical method.