摘要
目的比较双切口双钢板内固定与单侧锁定钢板内固定治疗Schatzker Ⅴ型胫骨平台骨折的疗效。方法回顾性分析2016年5月至2019年5月淮南新华医疗集团新华医院收治的患者,共纳入54例Schatzker Ⅴ型胫骨平台骨折患者。根据手术方法的不同,将双切口双钢板内固定治疗方案的30例纳入观察组,行单侧锁定钢板内固定治疗方案的24例纳入对照组,通过卡方检验、连续校正卡方检验及t检验比较两组围手术期及术后恢复相关指标(术中失血量、出院时间、切口总长度、手术时长、膝关节功能锻炼开始时间、完全负重下地锻炼时间、骨折愈合时间),测量患者术毕和术后12个月的内翻角(TPA)、后倾角(PA)和膝关节活动度(ROM),采用美国特种外科医院(HSS)膝关节评分系统评定患者膝关节功能及有无术后并发症。结果观察组与对照组的术中失血量、出院时间、切口总长度、手术时间差异无统计学意义(P>0.05);观察组膝关节功能锻炼开始时间显著短于对照组(t=20.549,P<0.05);观察组完全负重下地锻炼时间(t=20.549,P<0.05)和骨折愈合时间(t=20.095,P<0.05)均显著长于对照组。观察组术毕和术后12个月的TPA、PA和ROM与对照组差异无统计学意义(P>0.05)。观察组HSS优良率分与对照组无统计学差异(χ^(2)=0.244,P>0.05)。观察组术后并发症发生率显著低于对照组(χ^(2)=4.351,P<0.05)。结论双切口双钢板内固定与单侧锁定钢板内固定治疗Schatzker Ⅴ型均可获得满意的治疗效果。同时双切口双钢板内固定方案因其复位准确、固定牢靠等优点,可早期进行膝关节术后康复训练,从而有效降低术后膝关节僵直的发生。
Objective To compare the clinical outcomes of double-incision double-plate internal fixation and unilateral locking plate internal fixation in the treatment of Schatzker Ⅴ tibial plateau fracture.Methods A retrospective analysis of patients admitted to Huainan Xinhua Hospital of Xinhua Medical Group from May 2016 to May 2019.A total of 54 patients with Schatzker Ⅴ tibial plateau fractures were included.According to different surgical methods,30 cases of double-incision double steel plate internal fixation were included in the observation group,and 24 cases of single-sided locking steel plate internal fixation were included in the control group.The chi-square test,continuous correction chi-square test t test were used to compare the two groups of perioperative and postoperative recovery indicators(intraoperative blood loss,discharge time,total length of incision,operation time,knee functional exercise start time,full weight-bearing exercise time,fracture healing time).The varus angle(TPA),posterior angle(PA)and range of motion(ROM)of the knee joint after the operation,and at the postoperative 12 months were evaluated by the the Hospital for Special Surgery(HSS)knee scoring system to assess the patients’knee joint function and the presence or absence of postoperative complications.Results There was no significant difference in intraoperative blood loss,discharge time,total incision length,and operation time between the observation group and the control group(P>0.05).the start time of knee functional exercise in the observation group was significantly shorter than that of the control group(t=20.549,P<0.05).the observation group exercise time under full load(t=20.549,P<0.05)and fracture healing time(t=20.095,P<0.05)were significantly longer than the control group.There was no significant difference between the observation group and the control group in TPA,PA and ROM after operation and 12 months after operation(P>0.05).There was no significant difference in the HSS excellent and good rate of the observation group and the control group(χ^(2)=0.244,P>0.05).The incidence of postoperative complications in the observation group was significantly lower than that in the control group(χ^(2)=4.351,P<0.05).Conclusions Both double-incision double plate internal fixation and unilateral locking plate internal fixation for Schatzker Ⅴ type can obtain satisfactory therapeutic effects.The double-incision double-plate internal fixation scheme can be used for early rehabilitation training after knee joint surgery due to its advantages such as accurate reduction and firm fixation,thereby effectively reducing the occurrence of postoperative knee joint stiffness.
作者
李永冬
张结合
毛立科
朱玉洲
赵鸣
Li Yongdong;Zhang Jiehe;Mao Like;Zhu Yuzhou;Zhao Ming(Huainan Xinhua Hospital of Xinhua Medical Group,Huainan 232000,China)
出处
《中华关节外科杂志（电子版）》
CAS
CSCD
2021年第2期252-255,共4页
Chinese Journal of Joint Surgery(Electronic Edition)
基金
安徽省高校自然科学项目(KJ2019A0261)。
关键词
胫骨骨折
内固定器
治疗效果
Tibilal plateau fractures
Internal fixators
Treatment outcome
作者简介
通讯作者:李永冬,Email:s694195589@163.com。
