新型“L”型解剖锁定钢板在胫骨平台骨折中的应用效果观察

Application of a new type of “L” anatomical locking plate in tibial plateau fracture

目的:探讨新型"L"型解剖锁定钢板在胫骨平台骨折中的应用效果及对患者血流变学的影响。方法:选取2015年1月至2017年1月在四川省广安市人民医院骨科住院治疗的86例胫骨平台骨折患者,按随机数字表法分为观察组和对照组,每组43例。对照组患者采用传统锁定钢板内固定术进行治疗,观察组患者则采用新型"L"型解剖锁定钢板治疗。采用膝关节评分系统(HSS)和视觉模拟量表(VAS)评分,分别对两组患者手术前、后膝关节功能及疼痛程度进行评估,比较两组患者胫骨平台内翻角(TPA)和胫骨平台内侧后倾角(PA),观察两组患者血流变学指标变化,记录患者术后并发症发生情况。结果:术后3个月,两组HSS评分均较术前升高,VAS评分降低,且观察组改善程度显著优于对照组(P<0.05)。术后6个月,两组TPA均较术前显著降低,且观察组显著低于对照组(P<0.05)。术后7d,两组全血比黏度、红细胞电泳指数、血浆比黏度、红细胞压积以及血沉均较术前降低,且观察组明显低于对照组(P<0.05)。观察组并发症发生率显著低于对照组(P<0.05)。结论:新型"L"型解剖锁定钢板治疗可明显改善胫骨平台骨折患者膝关节功能及血液流动学,缓解术后疼痛,减少并发症发生,值得临床推广应用。

Objective： To investigate the clinical effect of a new type of “L” anatomical locking plate in tibial plateau fracture and the influence on hemorrheology indicators.Methods： A total of 86 patients with tibial plateau fracture treated in our hospital from January 2015 to January 2017 were selected,and randomly assigned to receive either traditional locking plate （control group, n =43） or “L” anatomical locking plate （observation group, n =43） fixation.Knee scoring system （HSS） and visual analogue scale （VAS） were used to evaluate the knee function and pain degree,respectively.The tibial plateau varus angle （TPA） and medial tilt angle （PA） of the tibial plateau,the changes of hemorrheology indicators and postoperative complications were observed and compared.Results： After 3 months of operation,the HSS score of both groups was significantly increased,while the VAS score was decreased.After 6 months of operation,the TPA and PA of both groups were markedly reduced.The changes were more obvious in the observation group compared with the control group （ P 〈0.05）.After 7 days,the whole blood viscosity,erythrocyte electrophoresis index,plasma viscosity,hematocrit and erythrocyte sedimentation rate of the groups were decreased,and the decrease of the observation group was more significant （ P 〈0.05）.The incidence of complications in the observation group was lower than that in the control group （ P 〈0.05）.Conclusion： The “L” type anatomical locking plate treatment could effectively improve the knee function,accelerate the blood flow,relieve pain and reduce complications in patients with tibial plateau fracture.