外侧锁定钢板与内侧支持钢板联合治疗胫骨平台骨折对患者膝关节功能恢复的影响

Effect of external locking plate combined with internal support plate in the treatment of fracture of tibial plateau on function recovery of knee joint

目的探讨外侧锁定钢板联合内侧支持钢板治疗胫骨平台骨折对患者膝关节功能恢复的影响。方法选取2016年1月至2018年5月本院收治的77例胫骨平台骨折患者作为研究对象,按双盲法将其分为联合组(n=40)与对照组(n=37),联合组患者给予外侧锁定钢板联合内侧支持钢板治疗,对照组患者给予内外侧双支持钢板固定治疗。经不同手术方式治疗后,对比两组患者膝关节功能恢复、术后康复及术后并发症发生情况。结果治疗前,两组患者的疼痛、肌力、关节活动度、关节稳定性、屈曲畸形及膝关节功能等HSS各项评分比较,差异均无统计学意义(P>0.05);治疗后,两组患者的HSS各项评分及总评分均显著升高,且联合组明显高于对照组,差异均具有统计学意义(P<0.05);治疗后,两组患者的骨折愈合时间、负重时间及住院时间比较,差异均无统计学意义(P>0.05);治疗后,联合组患者的对线丢失、复位丢失、膝关节不稳及深部感染等并发症的总发生率为10.00%,略低于对照组的13.51%,差异无统计学意义(P>0.05)。结论在临床胫骨平台骨折治疗中,外侧支持钢板联合内侧支持钢板治疗与内外侧双支持钢板固定治疗两种术式的术后并发症总发生率均较低。但因本研究中临床观察时间较短,两种术式在患者骨折愈合、负重及住院时间方面比较尚无明显差异,但外侧支持钢板联合内侧支持钢板治疗在促进患者膝关节功能恢复方面更具优势,值得临床推广与应用。

Objective To investigate the effect of external locking plate combined with internal support plate in the treatment of fracture of tibial plateau on the function recovery of knee joint. Methods A total of 77 patients with fracture of tibial plateau in our hospital from January 2016 to May 2018 were selected as the study objects and divided into combination group（n=40） and control group（n=37） according to the double blind method. The combination group was treated with external locking plate combined with internal support plate, while the control group was treated with internal and external double support plate fixation. After different surgical treatments, the function recovery of knee joint, postoperative rehabilitation and incidences of complications were compared between the two groups. Results Before treatment, there were no significant differences in the HSS scores of pain, myodynamia, joint range of motion, stability of joint, flexion deformity and knee joint function and total scores between the two groups（P〈0.05）. After treatment, the HSS scores and total scores of the two groups significantly increased, and those of the combination group were significantly higher than the control group（P〈0.05）. After treatment, there were no significant differences in the time of fracture healing, weight-bearing and hospitalization between the two groups（P〈0.05）. After treatment, the total incidence of complications of alignment loss, reduction loss, knee joint instability and deep infection in the combination group was 10.00%, which was slightly lower than 13.51% in the control group, but the difference was no statistically significant（P〈0.05）. Conclusion In the clinical treatment of fracture of tibial plateau, the total incidences of postoperative complications of the external locking plate combined with internal support plate and the internal and external double support plate fixation are low. Because of the short clinical observation time in this study, there are no significant differences in the time of fracture healing, weight-bearing and hospitalization between the two surgical methods. But the external locking plate combined with internal support plate has more advantages in promoting the function recovery of knee joint, which is worthy of clinical promotion and application.