不同损伤程度对胫骨平台骨折患者膝关节的影响分析

Analysis of the influence of the knee in patients with different degree of injury of the tibial plateau fracture

目的探讨不同损伤程度的胫骨平台骨折患者手术治疗后膝关节功能的差异。方法采用回顾性的分析2011年1月至2014年1月收治的147例胫骨平台骨折患者的临床资料、术后随访资料的整理,剔除资料不全的22例患者,纳入127例患者作为研究对象,根据Schatzker分型将127例患者分为6组（Ⅰ~Ⅵ型组）,比较6组患者术后膝关节功能恢复的差异。结果术后12个月,Ⅳ型骨折组、Ⅴ型骨折组和Ⅵ型骨折组的膝关节活动度显著的差于Ⅰ型骨折组、Ⅱ型骨折组、Ⅲ型骨折组（P〈0.05）,Ⅵ型骨折组、Ⅴ型骨折组的膝关节活动度显著的差于Ⅳ型骨折组（P〈0.05）。Ⅰ型骨折组、Ⅱ型骨折组、Ⅲ型骨折组的Rasmussen主观评分、放射学评价得分均显著的高于Ⅳ型骨折组、Ⅴ型骨折组和Ⅵ型骨折组患者（P〈0.05）,Ⅳ型骨折组的Rasmussen主观评分、放射学评价得分均显著的高于Ⅴ型骨折组和Ⅵ型骨折组患者（P〈0.05）。Ⅰ型骨折组、Ⅱ型骨折组、Ⅲ型骨折组的HSS膝关节功能评价优良率分别为96.29%、95.65%、90.91%均显著的高于Ⅳ型骨折组（75%）、Ⅴ型骨折组（42.11%）和Ⅵ型骨折组（37.50%）（P〈0.05）,Ⅳ型骨折组膝关节功能优良率显著的高于Ⅴ型骨折组和Ⅵ型骨折组患者（P〈0.05）。结论 Schatzker分型Ⅳ型骨折组、Ⅴ型骨折组和Ⅵ型骨折对患者术后膝关节功能恢复影响较为显著,尤其是Ⅴ型骨折组和Ⅵ型骨折,应重点关注这类患者的手术方法选择及术后恢复训练。

Objective To explore the differences in different degree of injury of the tibial plateau fracture operation treatment of patients after knee joint function. Methods In this study,retrospective analysis of 147 cases of tibial plateau was performed. All these patients were collected from the hospital department of orthopedics in 2011 January to 2014 January. The clinical data,postoperative follow-up data of these patients were collected and analyzed. The 22 patients with incomplete data were excluded. At last,127 patients were selected as the research object.According to the Schatzker classification,127 cases were divided into for the 6 group,the difference of functional recovery of knee joint after operation were compared between 6 groups. Results 12 months after operation,type Ⅳ fractures of type V group,fracture group and fracture group Ⅵ activity of knee joint had significantly difference on type I fracture type,fracture type III group,fracture group（ P〈0. 05）. Fracture of knee joint activity group Ⅵ,V fracture group had significantly difference in type Ⅳ fractures（ P〈0. 05）. Type I fracture group,type II fracture group,fracture group Rasmussen subjective score,radiographic evaluation scores were significantly higher than that of type Ⅳ fractures,type V and Ⅵ fracture fracture group（ P〈0. 05）. Rasmussen score,radiological evaluation of subjective score type Ⅳ fractures group were significantly higher than the V type fracture type Ⅵ group and fracture group（ P〈0. 05）. Type I fracture type group,the excellent and good rate of knee joint function evaluation of HSS group,fracture group were 96. 29%,95. 65%,90. 91% were significantly higher than that of type Ⅳ fractures（ 75%）,type V fracture group（ 42. 11%） and type Ⅵ fracture group（ 37. 50%）（ P〈0. 05）. The excellent and good rate of knee joint function of type Ⅳ fractures was significantly higher than that of type I fracture group and fracture group Ⅵ（ P〈0. 05）. Conclusion Schatzker type Ⅳ fractures of type V group,fracture group and fracture of type Ⅵ effect on postoperative knee function recovery is obvious,especially for the fracture group and fracture type V and Ⅵ. These physicians should focus on strengthening the selection and operation method of this kind of patient recovery after training.