前外侧入路排钉技术与双侧入路治疗复杂胫骨平台骨折疗效对比研究

Research on Comparison of Curative Effect of Anterolateral Approach Nail Ordering Technique and Bilateral Approach in the Treatment of Complex Tibial Plateau

目的比较分析前外侧入路排钉技术与双侧入路治疗复杂胫骨平台骨折的临床疗效。方法回顾性分析该院2013年2月—2015年2月收治的53例复杂胫骨平台骨折患者的临床资料,入选患者依据不同手术入路分为A组(前外侧入路患者,共31例)和B组(双侧入路患者,共22例),比较两组的治疗及恢复情况。结果 A组和B组的手术时间分别为(108.2±28.3)min和(115.1±27.5)min,比较差异无统计学意义(t=0.885,P=0.380);A组术中出血量(254.5±56.8)m L少于B组(313.4±45.5)m L,术后引流量(142.1±30.5)m L大于B组(123.5±26.7)m L,分别比较差异有统计学意义(t=4.029,P=0.000;t=2.301,P=0.026);随访12个月结果显示,A组膝关节功能恢复优良率为71.0%,B组为81.0%,组间差异无统计学意义(χ~2=0.82,P=0.366),A组出现1例(3.2%)切口感染,B组未出现术后并发症,两组术后并发症发生率差异无统计学意义(P=1.000)。结论前外侧入路排钉技术与双侧入路在治疗复杂胫骨平台骨折中各有优缺点及适应证,应依据患者骨折情况选取合适的入路方式。

Objective To compare and analyze the clinical curative effect of anterolateral approach nail ordering technique and bilateral approach in the treatment of complex tibial plateau. Methods 53 cases of patients with complex tibial plateau admitted and treated in our hospital from February 2013 to February 2015 were selected and divided into two groups according to different approach surgeries, the group A with 31 cases were the patients with anterolateral approach, while the group B with 22 cases were the patients with bilateral approach, and the treatment and recovery conditions were compared between the two groups. Results The difference in the operation time between the group A and the group B was not statistically significant, [（108.2±28.3）min vs（115.1±27.5）min]（t=0.885,P=0.380）; and the intraoperative bleeding amount in the group A was lower than that in the group B, [（254.5±56.8）m L vs（313.4±45.5）m L], and the postoperative drainage amount was more than that in the group B, [（142.1±30.5）m L vs（123.5±26.7）m L], and the differences were statistically significant（t=4.029,P=0.000;t=2.301,P=0.026）; and the 12-month follow-up results showed that the knee joint function recovery excellent and good rate in the group A and in the group B was respectively 71.0% and81.0%, and the differences between groups were not statistically significant（χ^2=0.82,P=0.366）, and in the group A, 1 case was with incision infection, accounting for 3.2%, and in the group B, there were no postoperative complications,and the differences in the postoperative complications between the two groups（P=1.000）. Conclusion The anterolateral approach nail ordering technique and bilateral approach in the treatment of complex tibial plateau each have advantages and disadvantages and indications, and we should select the proper approach ways according to the specific fractures of patients.