摘要
目的探讨扩大Carlson切口钢板内固定治疗胫骨后外侧平台合并前外侧平台骨折的疗效。方法采用回顾性病例系列研究分析2015年1月—2019年9月福建医科大学附属第一医院收治的16例胫骨后外侧平台合并前外侧平台骨折患者的临床资料,其中男10例,女6例;年龄22~59岁[(35.2±4.3)岁]。根据Schatzker分型:Ⅱ型10例,Ⅲ型4例,Ⅴ型1例,Ⅵ型1例。双柱骨折14例,三柱骨折2例。均采用扩大Carlson切口钢板内固定进行手术。评估骨折愈合情况及胫骨外侧平台后倾角情况。术后12个月进行Rasmussen膝关节功能评分。同时观察并发症发生情况。结果患者均获随访13~38个月[(18.3±4.6)个月]。患者均获骨性愈合。术后12个月,胫骨外侧平台后倾角为(11.5±4.7)°,与术前的(28.93±3.2)°比较差异有统计学意义(P<0.05)。术后12个月,膝关节功能Rasmussen评分为(25.8±1.1)分,与术前的(13.1±3.8)分比较差异有统计学意义(P<0.05),其中优9例(56%),良6例(37%),一般1例(6%),优良率达94%。无一例患者出现皮肤坏死、浅表或深部感染、内置物外露及骨髓炎等并发症。结论采用扩大Carlson切口钢板内固定治疗胫骨后外侧平台合并前外侧平台骨折,可有效复位、固定骨折,改善胫骨后外侧平台的后倾角,促进患者膝关节功能恢复,且无血管、神经损伤,值得推广应用。
Objective To investigate the clinical outcome of extended Carlson approach to plate fixation of tibial plateau fracture with combined posterolateral and anterolateral fragments.Methods A retrospective case series study was made on 16 patients with tibial plateau fracture with combined posterolateral and anterolateral fragments admitted to First Affiliated Hospital of Fujian Medical University from January 2015 to September 2019.There were 10 males and 6 females,with age of(35.2±4.3)years(range,22-59 years).According to the Schatzker fracture classification,type II was found in 10 patients,type III in 4,type V in 1 and type VI in 1.Two-column fractures were found in 14 patients and three-column fracture in 2 patients.All patients were treated by plate fixation through the extended Carlson approach.The anterior-posterior X-ray and 3D reconstruction CT scan test were taken at every 3 months after operation to assess fracture healing and posterior tilt angle of lateral tibial plateau.The Rasmussen knee function score was performed 12 months after operation.Complications were detected as well.Results All patients were followed up for 13-38 months[(18.3±4.6)months].All patients showed bone healing.At postoperative 12 months,the posterior tilt angle of lateral tibial plateau was reduced to(11.5±4.7)°,compared to preoperative(28.9±3.2)°(P<0.05).At postoperative 12 months,the Rasmussen score was(25.8±1.1)points compared with preoperative(13.1±3.8)points(P<0.05),and the results were excellent in 9 patients(56%),good in 6(37%),and fair in 1(6%),with the excellentgood rate of 94%.No complications were observed,such as skin necrosis,surgical site infection,internal fixator exposure or osteomyelitis.Conclusion For tibial plateau fracture with combined posterolateral and anterolateral fragments,plate fixation via the extended Carlson approach is effective to reduce and fix the fracture,decrease the posterior tilt angle of lateral tibial plateau and improve the recovery of postoperative knee function,with no neurovascular injury complications.
作者
王海
谢昀
林章雄
王发圣
吴贵
邱耀宇
Wang Hai;Xie Yun;Lin Zhangxiong;Wang Fasheng;Wu Gui;Qiu Yaoyu(Department of Orthopedics,First Affiliated Hospital of Fujian Medical University,Fujian Trauma Medical Center,Fuzhou 350004,China)
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2020年第10期905-911,共7页
Chinese Journal of Trauma
关键词
胫骨骨折
骨折固定术
内
手术入路
Tibial fractures
Fracture fixation,internal
Surgical approach
