复杂胫骨平台骨折2种手术治疗方法的比较分析

Comparison of two surgical methods for tibial plateau Schatzker Ⅴ,Ⅵ fractures

目的比较双切口双钢板内固定术与膝前正中切口锁定钢板内固定术治疗SchatzkerⅤ、Ⅵ型胫骨平台骨折的手术效果。方法 76例SchatzkerⅤ、Ⅵ型胫骨平台骨折采用膝前正中切口锁定钢板内固定术治疗38例(A组),采用双切口双钢板内固定术治疗38例(B组)。比较2组手术时间、术中出血量、住院时间、术后至开始负重时间、骨折愈合时间、胫骨平台内翻角(TPA)、胫骨平台内侧后倾角(PSA)、并发症及末次随访时Rasmussen膝关节功能评分。结果 B组手术时间、术中出血量、住院时间、术后至开始负重时间少于A组,B组术后TPA、PSA小于A组,差异均有统计学意义(P<0.05);但2组骨折愈合时间比较差异无统计学意义(P>0.05)。B组出现钉道感染、关节强直、膝内翻畸形、骨折延迟愈合的患者较A组少,差异有统计学意义(P<0.05);2组切口感染、皮肤坏死、内固定松动断裂、膝关节不稳、骨坏死及骨折不愈合并发症比较差异无统计学意义(P>0.05)。末次随访时Rasmussen膝关节功能评分:A组优5例,良16例,可10例,差7例,优良率55.3%;B组优14例,良15例,可6例,差3例,优良率76.3%;B组Rasmussen膝关节功能评分优于A组,差异有统计学意义(P<0.05)。结论对于SchatzkerⅤ、Ⅵ型胫骨平台骨折,双切口双钢板内固定术手术时间短,治疗效果较好,并发症较少。

Objective To compare the surgical results of the dual incisions double plate fixation and knee midline incision locking plate fixation in the treatment of Schatzker Ⅴ, Ⅵ tibial plateau fractures. Methods Seventy six patients with Schatzker Ⅴ, Ⅵ tibial plateau fractures were randomly divided into two groups, 38 were treated with via knee midline incision locking plate fixation（group A）, and 38 by the dual incisions double plate fixation（group B）. The efficacy of these two kinds of surgery was evaluated postoperatively. Results The operative time, blood loss, hospital stay, postoperative load time, tibial plateau varus angle, posterior slope angle of group B were significantly less than that of group A, there＇re statistically significant differences（P〈0.05）. There＇s no statistically significant differences in fracture healing time（P〈0.05）. There＇re statistically significant differences in complications, such as nail infection, ankylosis, varus deformity, fracture delayed union.There＇re fewer complications in the group B（P〉 0.05）. There＇re no statistically significant differences in the wound infection,skin necrosis, internal fixation loosening or breakage, knee instability, bone necrosis and nonunion between the two groups（ P〈0.05）. There＇re statistically significant differences in the comparisons of postoperative Rasmussen classification between two groups. Efficacy of group B was significantly better than that of the group A（P〈0.05）. Conclusion In the treatment of SchatzkerⅤ, Ⅵ type tibial plateau fractures, the clinical efficacy of the dual-incision double-plate fixation is superior to that of the anterior cruciate midline incision locking plate fixation, with shorter operative time and fewer complications.