摘要
目的探讨双钢板或三钢板内固定治疗胫骨平台粉碎性骨折的临床效果。方法选取安徽医科大学第三附属医院自2011年4月至2017年4月收治的89例胫骨平台粉碎性骨折患者为研究对象,所有患者均采用双钢板或三钢板内固定治疗。观察并记录患者术后骨折愈合情况、膝关节活动度、膝关节特种外科医院(HSS)评分、并发症发生率及下肢功能评分。结果所有患者均得到有效随访,随访时间为1~12个月。患者骨折愈合时间为3~7个月,平均骨折愈合时间为(5. 67±0. 89)个月;完全负重时间为4~11个月,平均完全负重时间为(7. 81±0. 54)个月。膝关节活动度方面,术前,伸膝活动度为0°~5°,平均伸膝活动度为(3. 40°±0. 52°),屈膝活动度为32°~65°,平均屈膝活动度为(41. 27°±0. 64°);术后1个月,伸膝活动度为0°~15°,平均伸膝活动度为(5. 90°±0. 73°),屈膝活动度为45°~92°,平均屈膝活动度为(75. 62°±0. 54°);术后12个月,伸膝活动度为0°~29°,平均伸膝活动度为(7. 23°±0. 89°),屈膝活动度为71°~120°,平均屈膝活动度为(92. 23°±5. 54°)。术后1、12个月,患者的伸膝和屈膝活动度均较术前明显改善,且术后12个月改善更为明显,差异有统计学意义(P <0. 05)。膝关节HSS评分方面,患者术前的膝关节HSS评分为20~43分,平均膝关节HSS评分为(31. 21±2. 12)分;术后膝关节HSS评分为60~91分,平均膝关节HSS评分为(78. 94±3. 21)分。患者术后的膝关节HSS评分较术前明显改善,差异有统计学意义(P <0. 05)。下肢功能评分方面,术前,患者下肢功能评分为22~41分,平均下肢功能评分为(33. 16±2. 74)分;术后6个月,患者下肢功能评分为51~65分,平均下肢功能评分为(59. 78±3. 23)分;术后12个月,患者下肢功能评分为69~80分,平均下肢功能评分为(71. 23±2. 49)分。术后6、12个月,患者的下肢功能评分均较术前明显改善,且术后12个月改善更为明显,差异有统计学意义(P <0. 05)。随访期间,3例患者轻度伤口感染,4例患者畸形愈合,2例患者切口边缘坏死,3例患者切口延迟愈合,并发症发生率为13. 5%(12/89),经对症处理后,并发症均得到不同程度缓解。结论双钢板或三钢板内固定治疗胫骨平台粉碎性骨折的临床效果显著,可促进患者术后康复和下肢功能改善。
Objective To investigate the clinical effect of two or three plates in the treatment of comminuted tibia plateau fractures.Methods A retrospective study was performed on 89 cases of patients with comminuted tibia plateau fractures who were admitted from April 2011 to April 2017. All the patients were performed two or three plates to be the internal fixation. The postoperative fracture healing condition,knee joint activity degree,knee joint mobility hospital for special surgery（ HSS） score,complication rates and lower limb function score were observed and recorded. Results All patients were effectively followed up for 1 to 12 months. The duration of fracture healing was 3 to 7 months,and the average duration of fracture healing was（ 5. 67 ± 0. 89） months. The full load time was 4 to11 months,and the average full load time was（ 7. 81 ± 0. 54） months. Knee joint activity degree,before surgery,the angle of knee extension was 0 ° to 5 °,average angle was（ 3. 40 ° ± 0. 52 °）,angle of knee bend was 32 ° to 65 °,the average angle was（ 41. 27 ° ±0. 64 °）; 1 month after surgery,the angle of knee extension was 0 ° to 15 °,average angle was（ 5. 90 ° ± 0. 73 °）,angle of knee bend was 45 ° to 92 °,average degree was（ 75. 62 ° ± 0. 54 °）; 12 months after surgery,the angle of knee extension was 0 ° to 29 °,average angle was（ 7. 23 ° ± 0. 89 °） and angle of knee bend was 71 ° to 120 °,average angle was（ 92. 23 ° ± 5. 54 °）. One and twelve months after surgery,both the knee extension and the knee mobility were significantly improved compared with that before surgery,and the improvement was more significant 12 months after surgery,with statistically significant differences（ P〈 0. 05）. The knee HSS score was 20 to 43 scores before surgery,average HSS score was（ 31. 21 ± 2. 12） scores; the knee HSS score was 60 to 91 scores before surgery,average HSS score was（ 78. 94 ± 3. 21） scores. The HSS score of knee joint after operation was significantly improved compared with that before operation,and the difference was statistically significant（ P〈 0. 05）. In terms of lower limb function score,patients＇ lower limb function score was 22 to 41 scores before surgery,and the average lower limb function score was（ 33. 16 ± 2. 74） scores. Six months after surgery,the lower limb function score was 51 to 65,and the average lower limb function score was（ 59. 78 ± 3. 23） scores.After 12 months,the lower limb function score was 69 to 80 and the average lower limb function score was（ 71. 23 ± 2. 49） scores. At6 and 12 months after surgery,the lower limb function score of the patients was significantly improved compared with that before surgery,and the improvement was more significant at 12 months after surgery,with statistically significant differences（ P〈 0. 05）. During the follow-up,3 patients had mild wound infection,4 patients had malformed healing,2 patients had incision edge necrosis,3 patients had delayed incision healing,nd the incidence of complications was 13. 5%（ 12/89）. After symptomatic treatment,the complications were alleviated to different degrees. Conclusion The clinical effect of two or three plate internal fixation for the treatment of comminuted fracture of tibial plateau is remarkable,which can promote the postoperative rehabilitation and the improvement of lower limb function
作者
姚涛
王伟
吕飞飞
杨参
YAO Tao;WANG Wei;LYU Fei-fei;YANG Sen(Department of Orthopedics,Hefei People＇s Hospital,Hefei 230001,China)
出处
《创伤与急危重病医学》
2018年第5期273-275,278,共4页
Trauma and Critical Care Medicine
关键词
双钢板
三钢板
内固定
胫骨平台骨折
联合入路
Double steel plate
Three steel plate
Internal fixation
Tibia plateau fracture
Combined approach
