用不同的手术方式治疗复杂性胫骨平台骨折的效果对比

Comparison of different operations for complicated fractures of tibial plateau

目的:比较用不同的手术方式治疗复杂性胫骨平台骨折的效果。方法:对在安岳县中医医院接受手术治疗的90例复杂性胫骨平台骨折患者的临床资料进行回顾性分析。根据手术方式的不同将这90例患者分为A组、B组和C组,每组各30例患者。为A组患者应用膝前外侧入路的单钢板内固定术进行治疗,为B组患者应用膝前正中入路的双钢板内固定术进行治疗,为C组患者应用膝前后联合入路的单钢板或双钢板内固定术进行治疗。然后比较三组患者手术的时间、术中的出血量、术后切口并发症(包括切口皮肤坏死、浅表切口感染、切口延迟愈合和深部切口感染)的发生情况、骨折愈合的时间和进行内固定的成功率。结果:三组患者术后切口并发症的发生率相比,P>0.05。A组患者和B组患者术中的出血量均少于C组患者,P<0.05。C组患者骨折愈合的时间短于A组患者和B组患者,其进行内固定的成功率高于A组患者和B组患者,P<0.05。结论:用膝前外侧入路的单钢板内固定术、膝前正中入路的双钢板内固定术和膝前后联合入路的单钢板或双钢板内固定术治疗复杂性胫骨平台骨折各有优缺点。临床医生应根据患者的实际情况选择合适的术式对其进行治疗。

objective： to compare the efficacy of different surgical methods for treating complex tibial plateau fractures. Methods： the clinical data of 90 patients with complex tibial plateau fractures who received surgical treatment in anyue county TCM hospital were retrospectively analyzed. These 90 patients were divided into group A, group B and group C according to different surgical methods, with 30 patients in each group. For group A, single plate fixation with anterior lateral approach of knee was used for treatment; for group B, double plate fixation with anterior central approach of knee was used for treatment; for group C, single plate or double plate fixation with combined approach of knee before and after was used for treatment. The time of operation, amount of blood loss, postoperative incision complications（including incision skin necrosis, superficial incision infection, delayed incision healing and deep incision infection）, time of fracture healing and success rate of internal fixation were then compared among the three groups of patients. Results： the incidence of postoperative incision complications in the three groups was P〉0.05. The intraoperative blood loss of patients in group A and group B was lower than that in group C, P〈0.05. The fracture healing time of group C was shorter than that of group A and group B, and the success rate of internal fixation was higher than that of group A and group B, P〈0.05. Conclusion： single plate fixation with anterolateral knee approach, double plate fixation with anterolateral knee approach and single plate or double plate fixation with anterolateral knee approach have advantages and disadvantages in the treatment of complex tibial plateau fractures. The clinician should select the appropriate operative method to treat the patient according to the actual situation.