顺势复位治疗胫骨平台骨折的临床研究

Clinical study of homeopathic bidirection-traction reduction device for tibial plateau fractures

目的探讨应用顺势复位治疗胫骨平台骨折的临床效果。方法采用回顾性病例对照研究分析上海市第十人民医院2016年1月~2017年4月收治的87例胫骨平台骨折患者的临床资料。按照治疗方法将患者分为顺势复位组和切开复位组。顺势复位组应用顺势双反牵引复位器复位,共47例,切开复位组共40例,两组患者均采用锁定钢板内固定。比较两组患者手术时间、术中出血量及术后6个月时根据Rasmussen影像学评分评估的患侧膝关节功能恢复情况。结果所有患者均获随访,随访时间5~8个月,平均为(6.4±1.0)个月,顺势复位组手术时间为(108±15)min,切开复位组为(129±16)min,两组数据差异有统计学意义(t=6.295,P<0.05);顺势复位组术中出血量为(67±23)ml,切开复位组为(93±22)ml,两组数据差异有统计学意义(t=5.313,P<0.05);Rasmussen影像学评分顺势复位组平均分数(23±4),优良率80.9%,切开复位组平均分数(20±5),优良率为65%,两组数据差异有统计学意义(t=4.599,P<0.05)。两组患者均得到骨性愈合,均未出现复位丢失、钢板松动及断裂等情况;切开复位组有3例患者术后出现切口感染,予加强抗感染消毒换药后均愈合良好。结论顺势复位治疗胫骨平台骨折成功率高,与切开复位比较,可缩短手术时间,减少术中出血量,膝关节功能恢复良好。

Objective To investigate the clinical effect of homeopathic bidirection- traction reductiondevice in the treatment of tibial plateau fractures. Methods A retrospective case-control study was conductedto analys the clinical data of 87 patients with tibial plateau fractures who were treated in ShanghaiTenth People＇s Hospital from January 2016 to April 2017. According to the method of treatment, patientswere divided into the bidirection-traction group and open reduction group. The bidirection-traction group appliedhomeopathic bidirection- traction device （47 cases）, open reduction group including 40 cases, bothgroup used locking plate fixation. The operative time, intraoperative blood loss and functional recovery ofthe affected knee were evaluated by Rasmussen imaging score at 6 months after operation. Results All patientswere followed up for 5-8 months with an average of （6.4±1.0） months. The duration of operation was（108±15） min for the bidirection-traction group and （129±16） min for the open reduction group, there wassignificant difference between two groups （t=6.295, P〈0.05）. The blood loss in the bidirection-traction groupwas （67±23） ml and the open reduction group was （93±22） ml （t=5.313, P〈0.05）. The mean score of Rasmussenimaging score was （23±04）, the excellent and good rate was 80.9%, and the average score of open reductionwas （20±5）, the excellent and good rate was 65%. There was significant difference between two groups（t=4.599, P〈0.05）. Both groups got bony union without loss of restitution, looseness and plate rupture. In theopen reduction group, there were 3 incision infection after operation, which healed well after strengtheninganti-infective dressing. Conclusions Homeopathy reduction has a high success rate in the treatment of tibialplateau fractures. Compared with open reduction, it can shorten the operation time, reduce the intraoperativeblood loss and restore the knee joint function well.