改良Carlson后外侧入路治疗胫骨平台单纯后外侧柱骨折

A Modified Carlson’s Posterolateral Approach for the Treatment of Posterolateral Coronal Fractures of the Tibial Plateau

摘要: 目的：探讨改良Carlson的后外侧入路锁定钢板内固定治疗胫骨平台后外侧骨折的手术方法及临床疗效。方法：自2010年1月至2013年12月，采用改良后外侧切口显露胫骨平台后外侧，对48例胫骨平台后外侧骨折进行手术治疗。男28例，女20例；年龄19~65岁，平均37岁。术后采用HSS评分标准评定关节功能，并通过对患膝TPA、PA角度的测量及关节屈伸活动度对疗效进行评估。结果：所有患者术后获12—18个月(平均15.7个月)随访，骨折均获愈合。所有患者术后3、6、12个月膝关节HSS评分差异均无统计学意义(P > 0.05)，术后即刻、3个月、6个月及12个月胫骨平台内翻角及后倾角比较差异均无统计学意义(P > 0.05)。无手术切口相关并发症发生，无腓总神经症状、无感染、内固定失效及螺钉断裂等并发症发生。结论“改良Carlson后外侧入路支撑钢板固定是治疗胫骨平台后外侧柱骨折的一种有效方法，能够充分显露手术区域，最大限度提供后外侧内固定的生物力学强度，是治疗胫骨平台后外侧柱骨折的理想入路。

Abstract: Objective: To introduce a modified Carlson’s posterolateral approach using locking plate for the treatment of posterolateral coronaI fractures of the tibial plateau. Methods: From January 2010 to December 2013, 45 patients with the posterolateral coronal fracture of the tibial plateau were operated on. They were 28 males and 20 females, with a mean age of 37 years (range, from 19 to 65 years). The patients were treated with buttress plate fixation via a modified Carlson’s posterolateral approach. The knee functions were estimated with the Hospital for SpeciM Surgery (HSS) score system at 3 months, 6 months and 1 year postoperatively. Imaging data based on the measurement of angle of knee TPA, PA and joint flexion mobility to evaluate the curative effect were compared immediately, 3, 6 and 12 months after operation respectively. Results: The 48 patients were followed up for an average of 15.7 months (range, from 12 to 18 months). All patients obtained bony union. There were no significant differences regarding the mean HSS score among 3 months, 6 months and 1 year postoperation (P > 0.05). There were no significance differences regarding the tibial plateau angle and posterior slope angle oil radiographies among immediate, 3, 6 and 1 2 months postoperation(P > 0.05). No complications associated with the approach were observed and there was no infection or fixation failure either. Conclusion: Because the modified Carlson’s posterolateral approach can provide direct visual exposure to protect ligamentous structures and the soft tissue around the posterolateral fragments, utmost to provide the biomechanical strength of the posterolateral internal fixation, it can be effectively used to treat posterolateral coronal fractures of the tibial plateau.