内固定与环形外固定架治疗闭合性胫骨平台骨折的对比研究

Comparison of internal versus circular external fixation for treatment of closed tibial plateau fracture

[目的]比较内固定与环形外固定架治疗闭合性胫骨平台骨折的疗效。[方法]回顾性分析2007年2月～2012年2月本院收治的闭合性胫骨平台骨折患者58例。按Schatzker分型:Ⅳ型20例,Ⅴ型20例,Ⅵ型18例。按手术方法分成两组:A组为内固定组,28例;B组为外固定支架组,30例。比较两组患者的手术时间、术后住院时间、患肢开始负重时间、临床疗效及术后并发症。临床疗效采用RRS放射学及KSS膝评分标准进行评价。随访时间6～14个月,平均12.1个月。[结果]A组手术时间(113.4±13.2)min、术后住院时间(15.3±2.1)d、患肢开始负重时间(14.4±2.5)周,术后RRS评分(14.9±2.7)分,术后KSS膝评分(76.4±5.2)分、功能评分(84.6±6.9)分。B组手术时间(105.7±9.8)min、术后住院时间(7.7±1.8)d、患肢开始负重时间(10.0±1.5)周,术后RRS评分(15.6±2.4)分,术后KSS膝评分(78.6±5.9)分、功能评分(86.5±6.5)分。两组在手术时间、术后住院时间、患肢开始负重时间,组间差异有统计学意义(P<0.05)。骨折分型与手术方法之间无交互作用(P>0.05);两组在术后RRS评分、术后KSS评分及并发症,组间差异无统计学意义(P>0.05)。[结论]两种方法治疗闭合性胫骨平台骨折,均获得满意的疗效。环形外固定架组能缩短患者的手术时间及术后住院时间,可以较早负重活动。

[ Objective ] To compare outcomes of closed tibial plateau fracture treated with internal fixation versus circular external fixation. [ Method ] Fifty-eight patients with closed tibial plateau fracture, who were treated sugically from February 2007 to February 2012,were analyzed retrospectively. According to Schatzker~ classification：20 cases were type IV,20 cases were type V, 18 cases were type VI. The patients were divided into group A, including 28 patients treated with open reduction and internal fixation, and group B,including 30 patients treated with circular external fixation. The parameters for evaluation in- cluded time of surgical procedure, time of postoperative hospitalization, starting time of weight bearing on the affected extremity, clinical therapeutic effect, complications. The therapeutic effect were assessed based on the Rasmussen~ Radiological Score and the Knee Society Score. All Fifty-eight patients were followed up ranging 6 to 14 months with an average of 12.1 months. [ Re- suit ] The group A treated with internal fixation：the time of surgical procedure was （113.4 ＋ 13.2 ）min, the time of postoperative hospitalization was （15.3 ~ 2.1 ） d,the starting time of weight bearing was （14.4 ~ 2.5 ） w, the postoperative RRS score was （14.9 ~ 2.7 ）, the postoperative KSS score was （76.4 ~ 5.2）, the postoperative functional score was （84.6 ~ 6.9）. The group B treated with circular external fixation：the time of surgical procedure was（ 105.7 ~ 9.8）min, the time of postoperative hospital- ization was （7.7 ＋ 1.8 ） d, the starting time of weight bearing was （ 10.0 ＋ 1.5 ） w, the postoperative RRS score was （ 15.6 ~ 2.4）, the postoperative KSS score was （78.6 ~ 5.9）, the postoperative functional score was （86.5 ~ 6.5 ）. There were signifi- cant differences in the time of surgical procedure, the time of postoperative hospitalization, the starting time of weight bearing （ P 〈 0.05 ）. There wasnt interaction between the fracture classification and the surgical methods （ P 〉 0.05 ）. There were no signif- icant differences in the postoperative RRS score, KSS score and complications （ P 〉 0.05 ）. [ Conclusion ] Both methods in treatment of closed tibial plateau fracture have good satisfactory therapeutic effect. The group B treated with circular external fix- ation is superior to the group A treated with internal fixation in the time of surgical procedure, the time of postoperative hospitali- zation, the starting time of weight bearing on the affected extremity.