3种入路在治疗胫骨平台后外侧骨折中的疗效比较  

Comparison on the curative effects of posterolateral fractures of tibial plateau with three surgical approaches

作　　者：钱利海 梁清宇 张辉 张道平 周明 QIAN Li-hai;LIANG Qing-yu;ZHANG Hui;ZHANG Dao-ping;ZHOU Ming(Dept of Orthopaedics,the Traditional Chinese Medical Hospital of Wuhu City,Wuhu,Anhui 241000,China)

机构地区：[1]芜湖市中医医院骨科,安徽芜湖241000

出　　处：《临床骨科杂志》2022年第5期731-735,共5页Journal of Clinical Orthopaedics

基　　金：安徽省高等学校自然科学研究项目(编号:KJ2019A1087)。

摘　　要：目的 比较Carlson后外侧入路、改良Carlson后外侧入路与前外侧入路在治疗单纯胫骨平台后外侧骨折中的临床疗效。方法 将18例单纯胫骨平台后外侧骨折患者按手术入路不同分为A组(采用改良Carlson后外侧入路,6例)、B组(采用Carlson后外侧入路,6例)和C组(采用前外侧入路,6例)。比较3组手术情况、胫骨外侧平台后倾角、膝关节活动度、HSS评分及Lysholm评分。结果 患者均获得随访,时间6~12个月。骨折均一期愈合。手术时间及术中出血量A组短(少)于B、C组(P<0.05)。切口长度及术后住院时间3组比较差异均无统计学意义(P> 0.05)。胫骨外侧平台后倾角:3组术后即刻及末次随访与术前比较差异均有统计学意义(P<0.05),末次随访与术后即刻比较差异均无统计学意义(P> 0.05),3组间比较差异均无统计学意义(P> 0.05)。末次随访时膝关节活动度、HSS评分、Lysholm评分3组比较差异均无统计学意义(P> 0.05)。结论 3种入路治疗胫骨平台后外侧骨折均能获得良好的临床疗效,但改良Carlson后外侧入路具有手术时间短、术中出血量少等优点。Objective To compare the clinical effects of Carlson posterolateral approach,improved Carlson posterolateral approach and anterolateral approach for treatment of simple posterolateral fractures of tibial plateau.Methods Eighteen patients with simple posterolateral fractures of tibial plateau were divided into group A(6 cases,improved Carlson posterolateral approach),group B(6 cases,Carlson approach)and group C(6 cases,anterolateral approach),according to different incision approaches. The operation situation,tibial lateral plateau posterior slope angle,knee range of motion,HSS scores,Lysholm scores were compared among the three groups.Results All patients were followed up for 6 ~ 12 months. All fractures got primary healing. The operation time and intraoperative blood loss volume in the group A were shorter(less) than those of the group B,C(P< 0. 05). There were no differences in incision length and postoperative hospitalization time among three groups(P> 0. 05). The posterior slope angles of tibial lateral plateau:three groups had statistical differences at the immediately postoperation and the last follow-up,compared with the preoperation(P< 0. 05),there were differences between the immediately postoperation and the last follow-up,while there were no statistical differences among the three groups(P> 0. 05). At the last follow-up,there were no statistical differences in the range of motion of knee joint, HSS score, Lysholm scores among the three groups(P>0. 05).Conclusions All three approaches can obtain good clinical effects in the treatment of posterolateral fractures of tibial plateau,while the improved Carlson posterolateral approach has the advantages of shorter operation time,and less intraoperative blood loss.

关 键 词：胫骨平台骨折 Carlson后外侧入路 改良Carlson后外侧入路 前外侧入路 

分 类 号：R683.42[医药卫生—骨科学] R687.3[医药卫生—外科学]