不同内固定术式治疗膝关节半脱位合并胫骨内侧平台骨折的疗效对比

Comparison of the efficacy of knee joint subluxation type tibial plateau fracture among different fixation methods

目的比较不同内固定术式治疗膝关节半脱位合并胫骨内侧平台骨折的临床疗效。方法选取我院2013年1月至2015年1月收治的膝关节半脱位合并胫骨内侧平台骨折患者90例,根据手术方法不同分为内侧T型钢板+拉力螺钉内固定(内侧钢板固定组)30例,外侧锁定钢板+拉力螺钉内固定(外侧钢板固定组)30例及双侧双钢板固定组30例。回顾性分析患者的临床资料,比较三组术中及术后一般资料、术后胫骨平台解剖学参数、Rasmussen复位解剖学评分及膝关节美国特种外科医院(Hospital for Special Surgery,HSS)评分。结果所有患者手术顺利并获得随访,术后3、6及12个月时双侧双钢板固定组胫骨平台内翻角(Tibial plateau-tibial shaft angle,TPA)及胫骨平台后倾角(Posterior slope,PS)均大于内侧钢板固定组及外侧钢板固定组,差异均有统计学意义(P<0.05)。术后3、6及12个月时双侧双钢板固定组Rasmussen复位解剖学评分及膝关节HSS评分均大于内侧钢板固定组及外侧钢板固定组,差异均有统计学意义(P<0.05)。至末次随访,双侧双钢板固定组手术优良率[93.3%(28/30)]高于内侧钢板固定组[70.0%(21/30)]及外侧钢板固定组[73.3%(22/30)],差异均有统计学意义(P<0.05)。结论对于合并膝关节半脱位的胫骨内侧平台骨折,前正中联合后内侧入路双钢板固定可充分暴露骨折端,解剖复位良好,膝关节功能恢复满意,效果优于单侧钢板联合拉力螺钉内固定术。

ObjectiveTo compare the efficacy of knee joint subluxation type tibial plateau fracture among different fixation methods. Methods90 cases of knee joint subluxation type tibial plateau fracture patients treated in our hospital from Jan.2013 to Jan.2015 were selected. They were divided into lateral plate fixation group（group A, 30 cases）, internal plate fixation group（group B, 30 cases） and double plate fixation group（group C, 30 cases）. The clinical data was compared among three groups. ResultsThe TPA and PS of group C were higher than those of group A and B at 3, 6 and 12 months after surgery（P〈0.05）. The Rasmussen and HSS scores of group C were higher than those of group A and B at 3, 6 and 12 months after surgery（P〈0.05）. The excellent rate of group C[93.3%（28/30）] was higher than those of group A[70.0%（21/30）] and group B[73.3%（22/30）] （P〈0.05）. ConclusionAccording to knee joint subluxation type tibial plateau fracture, double plate fixation is efficient to explore satisfactory anatomical restoration of knee joint.