摘要
目的探讨双侧入路、前外侧入路与前正中入路钢板内固定术在复杂胫骨平台骨折中的应用效果,以期为患者选取具有更好应用效果和更高价值的手术入路方式。方法回顾性分析2020年3月至2021年3月普宁华侨医院收治的80例复杂胫骨平台骨折患者的临床资料,按不同手术入路方式分为3组。A组(30例)患者选取双侧入路,B组(25例)患者选取前外侧入路,C组(25例)患者选取前正中入路。术后均随访6个月。对比3组患者各项临床指标,术前与术后3 d血清炎性因子水平,术后6个月膝关节功能优良率、美国纽约特种外科医院(HSS)评分,以及术后并发症发生情况。结果 A组患者术中出血量显著多于B、C组,负重活动、骨折愈合时间显著短于B、C组,住院时间显著长于B、C组,A、B组患者术后引流量显著多于C组;与术前比,术后3 d 3组患者血清C-反应蛋白(CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)水平均显著升高,且A组显著高于B、C组;术后6个月A组患者疼痛、功能、关节活动度、肌力、屈曲畸形、关节稳定性及HSS总分均显著高于B、C组(均P<0.05);3组患者膝关节功能总优良率与并发症总发生率比较,差异均无统计学意义(均P>0.05)。结论 3种入路手术方式在复杂胫骨平台骨折的手术治疗中均有较好的效果,相较于单侧入路方式,双侧入路钢板内固定术更有利于患者膝关节功能恢复,可缩短骨折愈合时间,提高整体康复效果。
Objective To investigate the application effects of bilateral,anterolateral and anterior median plate internal fixation in complex tibial plateau fractures,in order to select the surgical approach with higher application effect and value for patients.Methods A retrospective analysis of the clinical data of 80 patients with complex tibial plateau fractures treated by Puning Overseas Chinese Hospital from March 2020 to January 2021 were divided into 3 groups according to different surgical approaches.Patients in the group A(30 cases)were adopted bilateral approach,patients in the group B(25 cases) were adopted anterolateral approach,and patients in the group C(25 cases)were adopted anterior median approach.The clinical indicators of the 3 groups,the levels of serum inflammatory factors before and 3 d after the operation,the knee joint function excellent and good rate 6 months after the operation,the score of the New York Special Surgery Hospital(HSS),and the occurrence of complications were compared.Results The intraoperative blood loss in the group A was significantly more than those in the groups B and C.The weight-bearing activities and fracture healing time were significantly shorter than those in the groups B and C.The hospital stay was significantly longer than those in the groups B and C.The postoperative drainage in the groups A and B was significantly more than that in the groups C.Compared with preoperation,the levels of C-reactive protein(CRP),interleukin-6(IL-6) and tumor necrosis factor-α(TNF-α) in the 3 groups were significantly higher 3 d after the operation.However,the group A was significantly higher than those of groups B and C;the scores of the pain,function,joint range of motion,muscle strength,flexion deformity,joint stability and HSS total scores of the group A were significantly higher than those of group B and C(all P<0.05);there was no significant difference between the knee joint function excellent and good rate and the total incidence of complications in the 3 groups(all P>0.05).Conclusion The 3 surgical approaches have good results in the surgical treatment of complex tibial plateau fractures,compared with the unilateral approach,the bilateral approach steel plate internal fixation is more conducive to the recovery of knee joint function,shortening the healing time of fractures and improving the overall rehabilitation effect.
作者
郑泽龙
许喜林
ZHENG Zelong;XU Xilin(Department of Orthopedics,Puning Overseas Chinese Hospital,Jieyang,Guangdong 515300,China)
基金
揭阳市医学科学技术研究项目[编号:揭市卫[2020]64号-67]。
关键词
复杂胫骨平台骨折
双侧入路
单侧入路
前外侧入路
前正中入路
Complex tibial plateau fracture
Bilateral approach
Unilateral approach
Anterolateral approach
Anterior median approach
