摘要
目的比较膝内外侧双切口与膝前正中直切口双钢板内固定术对复杂胫骨平台骨折患者膝关节功能的影响。方法选取中国医科大学附属盛京医院2016年1月至2018年3月收治的行双钢板内固定术治疗的复杂胫骨平台骨折患者94例,采用随机数字表法分为对照组、观察组各47例,对照组给予膝前正中直切口,观察组给予膝内外侧双切口。比较两组患者围术期相关指标、胫骨平台后倾角、内翻角及膝关节功能评分的差异。结果两组术中出血量差异无统计学意义(P>0.05);观察组手术时间[(84.35±11.85)min]长于对照组[(62.14±10.05)min],治疗费用[(3.28±0.61)万元]多于对照组[(2.08±0.58)万元](t=9.80、9.12,均P<0.01)。观察组住院天数、开始负重时间、骨折愈合时间分别为(6.78±2.17)d、(44.76±9.33)d、(3.57±1.04)个月,均短于对照组的(10.24±2.25)d、(55.09±10.25)d、(5.57±1.37)个月(t=7.59、5.11、7.97,均P<0.01)。术后6个月,两组胫骨平台后倾角、内翻角差异均无统计学意义(均P>0.05);对照组术后12个月胫骨平台后倾角、内翻角较术后6个月均显著提高(均P<0.01);观察组术后12个月胫骨平台后倾角、内翻角与术后6个月比较,差异均无统计学意义(均P>0.05);观察组术后12个月胫骨平台后倾角[(6.49±1.14)°]、内翻角[(85.17±2.70)°]均较对照组[(8.05±1.55)°、(91.35±2.88)°]显著降低(t=5.56、10.73,均P<0.01)。两组术后12个月膝关节Rasmussen和Harris量表评分与术后6个月比较,差异均无统计学意义(均P>0.05);观察组术后6、12个月膝关节Rasmussen和Harris量表评分均较对照组明显提高(均P<0.01)。结论相比膝前正中直切口,膝内外侧双切口双钢板内固定术治疗虽然会导致复杂胫骨平台骨折患者手术时间延长,治疗费用增加,但可缩短患者住院时间,促进术后骨折愈合,促进原有解剖结构的恢复,从而可有效改善患者膝关节功能。
Objective To compare the effect of double plate internal fixation with medial and lateral knee incision and anterior straight knee incision on the knee function of patients with complex tibial plateau fracture.Methods From January 2016 to March 2018,94 patients with complex tibial plateau fractures treated with double plate internal fixation were divided into the control group(straight incision in the middle of the knee)and the observation group(double incisions on the inside and outside of the knee)according to the random digital table method,with 47 cases in each group.The differences of perioperative indicators,posterior tibial plateau inclination angle,varus angle and knee function scores between the two groups were compared.Results There was no statistically significant difference in intraoperative blood loss between the two groups(P>0.05).The operation time of the observation group[(84.35±11.85)min]was longer than that of the control group[(62.14±10.05)min],the treatment cost of the observation group[(3.28±0.61)ten thousand CNY]was more than that of the control group[(2.08±0.58)ten thousand CNY](t=9.80,9.12,all P<0.01).The days of hospitalization,the time of loading and the time of fracture healing in the observation group were(6.78±2.17)d,(44.76±9.33)d,(3.57±1.04)months,which were shorter than those in the control group[(10.24±2.25)d,(55.09±10.25)d,(5.57±1.37)months](t=7.59,5.11,7.97,all P<0.01).There were no statistically significant differences in the posterior inclination angle and varus angle of the tibial plateau between the two groups at 6 months after surgery(all P>0.05).In the control group,the posterior inclination angle and varus angle of the tibial plateau were significantly increased at 12 months after operation compared with 6 months after operation(all P<0.01).There were no statistically significant differences in the posterior inclination angle and varus angle of the tibial plateau in the study group between 12 months after surgery and 6 months after surgery(all P>0.05).At 12 months after operation,the tibial plateau caster angle[(6.49±1.14)°]and the varus angle[(85.17±2.70)°]in the observation group were significantly lower than those in the control group[(8.05±1.55)°and(91.35±2.88)°](t=5.56,10.73,all P<0.01).There were no statistically significant differences in the Rasmussen and Harris scales scores of knee joints between 12 months after surgery and 6 months after surgery in the two groups(all P>0.05).The results of Rasmussen scale and Harris scale in the study group were significantly higher than those in the control group(all P<0.01).Conclusion Compared with the knees straight incision,although knee inside and outside double incision double plate fixation treatment for patients with complex tibial plateau fractures can lead to increased operation time,high cost of treatment,but can shorten in-hospital time,promote the fracture healing after surgery,promote the recovery of the original anatomical structures,which can effectively improve the function of knee joint,thus is worthy of clinical application.
作者
张振君
白伦浩
Zhang Zhenjun;Bai Lunhao(Joint Movement Medical Ward,Shengjing Hospital Affiliated to China Medical University,Shenyang,Liaoning 110022,China)
出处
《中国基层医药》
CAS
2020年第17期2049-2053,共5页
Chinese Journal of Primary Medicine and Pharmacy
基金
国家自然科学基金资助项目(81772420)。
关键词
骨折
胫骨平台
骨折固定术
内
膝内外侧
双切口
膝前正中直切口
双钢板
膝关节功能
Fracture
Tibial plateau
Fracture fixation,internal
Anterolateral knee
Double incision
Anterolateral straight knee incision
Double plate
Knee joint function
