摘要
目的比较采用Carlson后外侧、后正中两种入路置入“T”型锁定钢板内固定治疗胫骨平台后外侧骨折的临床疗效。方法前瞻性分析2017年3月—2019年1月武警四川总队医院外三科收治的92例胫骨平台后外侧骨折患者资料,男性59例,女性33例;年龄25~53岁,平均40.7岁;Schatzker分型Ⅱ型55例,V型37例;致伤原因道路交通伤44例,钝器挫伤31例,高处坠落伤17例。随机数字表法将患者分为后外侧入路组(n=46例)和后正中入路组(n=46例),均采用T型锁定钢板内固定治疗。评价手术和术后恢复相关指标(膝关节功能、疼痛程度、生活质量和并发症)。结果患者均获12个月随访。后外侧入路组切口长度(10.21±2.65)cm、骨折显露时间(20.53±4.16)min、手术时间(82.35±6.25)min、术中出血量(223.15±53.26)mL少于后正中入路组(16.03±3.74)cm、(32.01±5.26)min、(91.12±8.46)min、(269.54±68.49)mL,P<0.05。后外侧入路组术后1、3、6、12个月美国纽约特种外科医院(HSS)评分(53.26±12.49)、(68.12±15.37)、(79.35±13.05)、(85.12±7.54)分、Rasmussen评分(15.12±5.62)、(19.35±6.51)、(23.15±5.11)、(26.31±3.52)分、欧洲五维健康量表(EQ-5D)指数(0.71±0.23、0.86±0.29、0.89±0.31、0.91±0.07)高于后正中入路组HSS评分(49.35±10.52)、(61.29±12.05)、(69.03±12.47)、(82.12±6.02)分;Rasmussen评分(13.26±4.16)、(17.15±6.09)、(19.24±4.15)、(24.15±3.70)分;EQ-5D指数0.65±0.16、0.73±0.21、0.77±0.26、0.79±0.19,P<0.05,视觉模拟评分(2.05±0.61)、(1.32±0.42)、(0.91±0.32)、(0.54±0.06)分低于后正中入路组(3.95±1.05)、(2.11±0.71)、(1.82±0.56)、(1.53±0.42)分,P<0.05。两组骨折愈合时间、完全负重时间、胫骨平台内翻角、胫骨平台后倾角、并发症发生率比较差异无统计学意义(P>0.05)。结论Carlson后外侧、后正中两种入路置入“T”型锁定钢板均可提供稳定的内固定,Carlson后外侧入路操作简便,术后膝关节功能恢复好,减轻疼痛程度,提高生活质量。
Objective To compare the application effect of Carlson’s posterolateral approach and posterior median approach in the treatment of posterolateral tibial plateau fracture with T type locking plate.Methods From Mar.2017 to Jan.2019,92 cases of posterolateral tibial plateau fracture treated in the Third Department of Surgery of Scihuan Armed Police Corps Hospital were prospectively analyzed,including 59 males,and 33 females,aged 25-53 years,with an average age of 40.7 years.Schatzker type:55 cases of TypeⅡ,and 37 cases of type V.Injury mechanism included:traffic injury in 44 cases,blunt force injury in 31 cases,and falling from high altitude in 17 cases.The patients were divided into posterolateral approach group(n=46)and posterior median group(n=46)by the random number table method.All patients were treated with T-shaped locking plate internal fixation.Indicators related to surgery and postoperative recovery,knee function,pain,quality of life,and complications were evaluated.Results All patients recevied outpatients follow-up for 12 months.Incision length[(10.21±2.65)cm],fracture exposure time[(20.53±4.16)minutes],operation time[(82.35±6.25)minutes]and intraoperative blood loss[(223.15±53.26)mL]in the posterolateral approach group were less than those in the posterior median approach group[(16.03±3.74)cm,(32.01±5.26)minutes,(91.12±8.46)minutes,(269.54±68.49)mL],P<0.05.Hospital for Special Surgery(HSS)scores[(53.26±12.49),(68.12±15.37),(79.35±13.05),(85.12±7.54)points],Rasmussen scores[(15.12±5.62),(19.35±6.51),(23.15±5.11),(26.31±3.52)points]and European Quality of 5-Dimensions(EQ-5D)indexes(0.71±0.23,0.86±0.29,0.89±0.31,0.91±0.07)of the posterolateral approach group were higher than those of the posterior median approach group[HSS score:(49.35±10.52),(61.29±12.05),(69.03±12.47),(82.12±6.02)points,Rasmussen score:(13.26±4.16),(17.15±6.09),(19.24±4.15),(24.15±3.70)points;EQ-5D index:(0.65±0.16,0.73±0.21,0.77±0.26,0.79±0.19)]at 1,3,6,12 months after surgery.Visual analog scale(VAS)[(2.05±0.61),(1.32±0.42),(0.91±0.32),(0.54±0.06)points]were lower than those of the posterior median approach group[(3.95±1.05),(2.11±0.71),(1.82±0.56),(1.53±0.42)points],P<0.05,but there was no statistical difference in fracture healing time,complete weight-bearing time,varus angle,posterior slope of tibial plateau,and complication rate between the two groups(P>0.05).Conclusion Both Carlson posterolateral approach and posterior median approach with T-shaped locking plate can provide stable internal fixation on the posterolateral tibial plateau.The Carlson posterolateral approach is easy to operate,which is conducive to postoperative functional recovery of the knee joint,relief of pain,and improvement of the patient’s quality of life.
作者
曾可培
罗志勇
丁培根
高峰
曾清明
Zeng Kepei;Luo Zhiyong;Ding Peigen;Gao Feng;Zeng Qingming(Third Department of Surgery,Sichuan Armed Police Corps Hospital,Leshan,Sichuan 614000,China;Department of Orthopaedics,Chengdu Office Hospital of the People’s Government of Tibet Autonomous Region,Chengdu 610041,China;Department of Orthopaedics,Chongqing Tongnan District People’s Hospital,Chongqing 402660,China)
出处
《创伤外科杂志》
2021年第8期593-598,共6页
Journal of Traumatic Surgery
基金
四川省医学科研课题计划项目(S2016245)
西藏自治区科技计划项目(XZ201801-6-B-06)。
关键词
胫骨平台骨折
锁定钢板
入路
内固定
tibial plateau fracture
locking plate
approach
internal fixation
作者简介
通信作者:曾清明,E-mail:741045512@qq.com。
