摘要
目的探讨三切口联合入路与膝关节镜辅助下前外侧入路治疗累及后外侧胫骨平台骨折的疗效。方法前瞻性分析中南大学湘雅医学院附属海口医院2016年11月至2018年12月收住入院的94例累及后外侧胫骨平台骨折患者,按住院号单双平均分成两组,对照组(n=47)予三切口联合入路手术治疗,研究组(n=47)予膝关节镜辅助下前外侧入路手术治疗。观察两组入组时、出院时日本骨科协会评估治疗分数(JOA评分)、膝关节评分量表(Lysholm评分)、膝关节活动度、疼痛介质、炎症因子变化并比较,比较两组手术时间、术中出血量以及影像学等指标变化情况。结果(1)两组出院时疼痛评分、行走功能评分、稳定性评分、总分较入组时均显著升高(P <0. 05),且研究组显著高于对照组(P <0. 05)。(2)两组出院时屈曲、伸直、内旋、外旋较入组时均显著升高(P <0. 05),且研究组显著高于对照组(P<0. 05)。(3)研究组手术时间、术中出血量、住院时间显著低于对照组,创伤性关节炎发生率显著低于对照组(P <0. 05),两组负重时间、骨折不愈合、关节面塌陷、内固定情况、内翻角、后倾角比较差异无显著性(P> 0. 05)。(4)两组出院时较入组时P物质(SP)、前列腺素F2(PGF2)、神经肽Y(NPY)、白细胞介素-1β(IL-1β)、肿瘤坏死因子-α(TNF-α)均显著降低(P <0. 05),且研究组显著低于对照组(P <0. 05)。结论与三切口联合入路手术比较,膝关节镜辅助下前外侧入路治疗累及后外侧胫骨平台骨折疗效确切,能提高膝关节功能和活动度,降低创伤性关节炎和关节面塌陷发生,缩短围术期时间,降低炎症因子和疼痛介质含量。
Objective To investigate the effect of three incisions combined with anterolateral approach assisted by knee arthroscopy in the treatment of posterolateral tibial plateau fractures. Methods 94 patients with posterolateral tibial plateau fractures admitted from November 2016 to December 2018 were retrospectively analyzed. They were divided into two groups on average according to the number of hospitalization. The control group (n=47) was treated with three incisions combined with anterolateral approach, and the study group (n=47) was treated with anterolateral approach assisted by knee arthroscopy. The changes of JOA score, Lysholm score, knee joint mobility, pain mediators and inflammatory factors were observed and compared between the two groups at admission and discharge. The changes of operation time, intraoperative bleeding volume and imaging parameters were compared between the two groups. Results ①The pain score, walking function score, stability score and total score of the two groups were significantly higher than those of the control group ( P <0.05), and the research group was significantly higher than that of the control group ( P <0.05).②The flexion, straightening, internal rotation and external rotation of the two groups were significantly higher than those of the control group ( P <0.05), and the study group was significantly higher than that of the control group ( P < 0.05).③The operation time, intraoperative bleeding volume and hospitalization time in the study group were significantly lower than those in the control group, and the incidence of traumatic arthritis and articular surface collapse were significantly lower than those in the control group ( P <0.05). There were no significant differences in the remaining weight-bearing time, fracture nonunion, internal fixation, varus angle and backward inclination angle ( P >0.05).④Substance P (SP), prostaglandin E2 (PGF2), neuropeptide Y (NPY), interleukin-1β(IL-1β) and tumor necrosis factor-α(TNF-α) were significantly lower in the two groups than in the control group ( P <0.05), which in the study group were significantly lower than those in the control group ( P <0.05). Conclusion The anterolateral approach assisted by knee arthroscopy is effective in the treatment of posterolateral tibial plateau fractures. It can improve knee function and mobility, reduce traumatic arthritis and joint collapse, shorten perioperative time, and reduce inflammatory factors and pain mediators.
作者
邢晓伟
郭祥
涂源源
XING Xiao-Wei;GUO Xiang;TU Yuan-yuan(Department of Orthopedics,Central South University Xiangya School of Medicine Affiliated Haikou Hospital,Haikou Hainan 570208,China.)
出处
《临床和实验医学杂志》
2019年第18期1988-1992,共5页
Journal of Clinical and Experimental Medicine
基金
海南省自然科学基金项目(编号:2017HN23586)
关键词
后外侧胫骨平台骨折
三切口联合入路
关节镜
前外侧入路治疗
关节功能
关节活动度
Posterolateral tibial plateau fracture
Three-incision combined approach
Arthroscopy
Anterolateral approach
Joint function
Joint mobility
作者简介
通讯作者,郭祥,E-mail:guoxiang66@126.com.
