改良外侧胫骨平台骨折塌陷关节面复位方法的临床运用分析

Clinical Analysis on Improved Reduction Method of Collapsed Articular Surface of Modified Lateral Tibial Plateau Fractures

目的探究改良外侧胫骨平台骨折塌陷关节面复位方法的临床疗效及运用方式。方法选取2008年5月至2010年5月解放军第一八八医院骨科收治的93例外侧胫骨平台骨折患者,根据患者意愿分为改良组52例和关节镜组41例,分别接受改良骨折塌陷关节面复位及关节镜辅助下内固定,对比两组患者术后关节面塌陷情况、膝关节功能恢复情况及并发症,分析疗效。结果改良组术后即刻、末次随访塌陷高度分别为(0.93±0.18)mm和(1.04±0.19)mm,均显著低于关节镜组(P<0.05),两组患者术后膝关节主动活动度差异无统计学意义(P>0.05)。改良组治疗效果优37例、良11例,优良率为92.3%;关节镜组治疗效果优13例、良16例,优良率为70.7%,改良组膝关节功能显著优于关节镜组(P<0.05)。改良组出现1例创伤性关节炎,1例关节僵硬,并发症率为3.8%;关节镜组出现2例膝关节内翻畸形,2例创伤性关节炎,1例关节僵硬,并发症率为12.2%,改良组并发症率显著低于关节镜组(P<0.05)。结论改良外侧胫骨平台骨折塌陷关节面复位方法较传统切开内固定、关节镜辅助内固定均具有更好的疗效,是改善患者症状、保证其生活质量的有效方式,值得临床广泛推广应用。

Objective To explore the clinical effect and apphcation method of improved reduction of the collapsed articular surface of the lateral tibial plateau fracture. Methods A total of 93 cases of tibial plateau fractures from Department of Orthopedics of PLA 188th Hospital from May 2008 to May 2010 were divided into improved treatment group （ n = 52） and arthroscopy group （ n = 41 ）, who received the improved reduction of collapsed articular surface reduction of the fracture and arthroscopic internal fixation respectively, and the postoperative articular surface collapse, knee joint function recovery and complications of the two groups were compared and the efficacy analysis was done. Results The collapse height at the time immediate after the operation,the last follow-up were （0.93 ±0.18） mm, （ 1.04 ±0.19） mm,both significantly lower than the arthroscopic group（ P 〈 0.05 ）, the knee joint activity of the two groups had no statistically signficant difference（P 〉0.05 ） ;37 cases were excellent, 11 cases were good in the improved treatment group making an excellent and good rate of 92.3%, while the corresponding number of the arthroscopic group was 13 cases and 16 cases respectively,forming an excellent and good rate of 70.7% ,therefore the function of knee joint of the improved treatment group was significantly better than the arthroscopic group（P 〈0.05 ） ;there was 1 case of traumatic arthritis and 1 case of ankylosis in the improved treatment group, forming an complication rate of 3.8% ,while there wer 2 cases of varus knee deformity,2 cases of traumatic arthritis, and 1 case of ankylosis in the arthroscopy group, forming an complication rate of 12.2%, therefore the complication incidence of the improved treatment group was significantly lower than the arthroscopic group （ P 〈 0.05 ）. Conelusion Improved collapsed articular surface reduction method for lateral tibial plateau fracturehas a better therapeutic effect than the traditional open reduction and internal fixation, arthroscopy assisted internal fixation, which is an effective method to improve the symptoms of patients and ensure the quality of life, thus is worthy of clinical popularization and application.