三种手术入路治疗胫骨平台后外侧骨折的临床疗效观察  

Clinical efficacy of three surgical approaches for the treatment of posterolateral tibial plateau fractures

作　　者：张航 阳明明[2] 梁安霖[2] 高仕长[2] Zhang Hang;Yang Mingming;Liang Anlin;Gao Shichang(Department of Emergency Trauma Surgery,The First People’s Hospital of Yunnan Province,Kunming 650032,China;Department of Orthopedics,Orthopedic Laboratory of Chongqing Medical University,The First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China)

机构地区：[1]云南省第一人民医院急诊创伤外科,昆明650032 [2]重庆医科大学附属第一医院骨科,重庆医科大学骨科实验室,重庆400016

出　　处：《创伤外科杂志》2023年第11期824-829,837,共7页Journal of Traumatic Surgery

摘　　要：目的 研究Carlson后外侧入路、Frosch入路和腓骨头截骨入路治疗累及胫骨平台后外侧骨折的临床疗效及特点,为胫骨平台后外侧骨折的手术入路选择提供参考。方法 回顾性分析2018年1月—2021年12月重庆医科大学附属第一医院骨科手术治疗的累及胫骨平台后外侧骨折患者22例,男性14例,女性8例;年龄22~69岁,平均43.5岁。按手术入路不同分为Carlson后外侧入路组(6例)、 Frosch入路组(8例)、腓骨头截骨入路组(8例)。Carlson后外侧入路于膝关节的后外侧作切口,在腓肠肌外侧头和比目鱼肌之间进行手术操作,钢板从后方支撑固定。Frosch入路通过一个切口、两个手术窗进行操作,用前外侧钢板螺钉固定。腓骨头截骨入路通过截断腓骨头获得更大手术视野,术后再固定。术后3、6、9、12个月门诊随访摄片,术后12个月根据Rasmussen放射评分评价复位质量、美国特种外科医院(the Hospital for Special Surgery, HSS)膝关节功能评分、膝关节后外侧检查稳定性。结果 Carlson后外侧入路多用于改良Schatzker CT分型为ⅡP型骨折(胫骨平台后外侧劈裂塌陷骨折);Frosch入路和腓骨头截骨入路常用于ⅡA+P型(胫骨平台后外侧合并前外侧劈裂塌陷骨折)。术后随访时间12~18个月,平均14.2个月,骨折平均愈合时间4.3个月。Carlson后外侧入路组平均手术时间(85.0±5.5)min,术中出血量(53.3±6.2)mL,术后12个月HSS评分(88.7±0.6)分,Rasmussen放射评分(17.3±0.4)分。Frosch入路组平均手术时间(133.8±16.3)min,术中出血量(91.3±7.4)mL,术后12个月HSS评分(88.6±1.0)分,Rasmussen放射评分(16.8±0.4)分。腓骨头截骨入路组平均手术时间(184.9±13.9)min,术中出血量(250.0±41.2)mL,术后12个月HSS评分(88.4±1.0)分,Rasmussen放射评分(16.5±0.3)分。各组间手术时间及术中出血量比较差异有统计学意义(P<0.05);HSS评分及Rasmussen放射评分比较差异无统计学意义(P>0.05)。胫骨外旋�Objective To explore the clinical efficacy and characteristics of posterolateral fractures involving the tibial plateau by Carlson approach(posterolateral),Frosch approach or fibular head osteotomy approach,and to provide reference for the selection of surgical approaches for this kind of fracture.Methods A retrospective study was conducted on 22 patients with posterolateral fractures of the tibial plateau treated surgically in the Department of Orthopaedics of the First Affiliated Hospital of Chongqing Medical University from Jan.2018 to Dec.2021.There were 14 males and 8 females aged 22-69 years,mean 43.5 years.Based on the adopted surgical approaches,patients were divided into three groups:Carlson approach group(an incision was made on the posterolateral side of the knee joint,and the surgical operation was performed between the lateral gastrocnemius muscle and the soleus muscle,the steel plate was supported and fixed posteriorly,n=6);Frosch approach group(operation was made via an incision and two operating window and fixation was made by anterolateral plate screws,n=8);and fibular head osteotomy group(a larger surgical field of view was obtained by osteotomy of the fibula head and fixation was performed later,n=8).Outpatient follow-up was conducted at 3,6,9 and 12 months after operation when radiographs were taken.At 12 months,the quality of fracture reduction was evaluated according to the Rasmussen radiological score,knee function by the Hospital for Special Surgery(HSS)score,and knee stability by the tibial external rotation test.Results Based on the revised Schatzker CT classification,the Carlson approach was mostly used for typeⅡP fractures(split-collapse fractures of posterolateral plateau),while the Frosch approach and fibular head osteotomy were more commonly applied to typeⅡA+P fractures(split-collapse fractures of posterolateral and anterolateral tibial plateau).Patients were followed up for 12-18 months,mean 14.2 months;fracture union was observed in an average of 4.3 months.For the Carlson ap

关 键 词：胫骨平台骨折 膝关节 入路 

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