3种入路内固定联合VSD治疗SchatzkerⅤ型、Ⅵ型骨折效果观察

The effect observation of Schatzker Ⅴ,Ⅵ fracture after three approach-and-internal fixations and VSD combination treatment

目的探讨复杂型胫骨平台骨折的手术方式选择及其治疗效果和术后并发症的差异。方法对收治的66例SchatzkerⅤ型、Ⅵ型急诊骨折患者的临床诊治经过及术后随访资料进行回顾性分析,根据手术方式分为A组(18例,膝前外侧切口单钢板内固定)、B组(24例,膝内外侧双切口双钢板内固定)、C组(24例,膝内外后多切口三钢板内固定),3组患者术后均进行负压引流(VSD)治疗。结果 B组的手术时间(133.8±15.4)min、术中出血量(348.4±68.5)mL显著高于其他两组患者(P<0.05),A组的术后负重开始时间(70.0±4.2)d显著长于其他两组患者(P<0.05)。B、C组术后第6、12个月及末次随访的膝关节功能HSS评分均显著高于A组(P<0.05)。末次随访B、C组的优良率分别为87.50%、83.33%,均显著高于A组的55.56%(P<0.05)。结论膝前外侧切口单钢板内固定具有操作简单的优势,但术后膝关节的功能恢复不及膝内外侧双切口双钢板内固定、膝内外后多切口三钢板内固定术。

Objective To investigate the choice of surgical methods for the treatment of complex tibial plateau fractures and the difference of the therapeutic effect and postoperative complications.Methods A total of 66 patients whose type were retrospective analysed.According to the operation mode,all cases were divided into group A（18cases,anterior knee lateral incision in the single plate fixed）,group B（24cases,knee medial and lateral two incision double plate fixation）,group C（24cases,knee external incision three plate internal fixation）.Negative pressure drainage（VSD）was performed in the 3groups after operation.Results The operation time[（133.8±15.4）min]and bleeding[（348.4±68.5）mL]in the B group were significantly higher than those in the other two groups（P〈0.05）.The time of weight loading after operation of group A[（70±4.20）d]was significantly longer than those of the other two groups（P〈0.05）.HSS scores of group B and C were significantly higher than those in group A（P〈0.05）at 6and 12 months after operation.The excellent rates of group B and C were 87.50% and 83.33% at the last follow-up,which were significantly higher than those in group A（55.56%）（P〈0.05）.Conclusion Single plate internal fixation with anterior lateral incision has advantages of simple operation,but the functional recovery of the knee joint is not inferior to that of the double incision double plate internal fixation and internal and external fixation of three steel plate with multiple incision.