闭合性复杂胫骨平台骨折最佳手术时机及其影响因素

Optimal Operation Timing and Its Influencing Factors of Closed Complex Tibial Plateau Fractures

目的:研究闭合性复杂胫骨平台骨折最佳手术时机与手术入路选择,并观察影响骨折愈合的因素,为临床诊疗提供依据。方法:选取2015年6月-2016年7月本院收治的闭合性复杂胫骨平台骨折患者130例,根据手术入路方式不同分为Ⅰ组(32例膝前外侧单切口单钢板内固定)、Ⅱ组(33例膝内外侧切口双钢板内固定)、Ⅲ组(36例膝前正中直切口双钢板内固定)、Ⅳ组(9例膝前后联合入路单或双钢板内固定)、Ⅴ组(20例小切口或闭合复位外固定架固定),比较各组手术出血量、切口感染、内固定失败、骨折愈合时间、关节功能,观察不同手术时机延迟愈合、皮肤缺血坏死、浅表感染、深部感染发生率,应用Logistic多因素回归分析影响骨折愈合的因素。结果:V组术中出血量最少,Ⅳ组术中出血量最多;Ⅳ组无切口感染,V组切口感染发生率最高;Ⅳ组无内固定失效,V组内固定失效率最高;Ⅳ组骨折愈合时间最短,Ⅰ组骨折愈合时间最长;Ⅳ组关节功能优良率(100%)最高,V组关节功能优良率最低。5~8 d行手术无延期愈合、皮肤缺血坏死发生,7~8 d行手术浅表感染发生率最低,7~8 d和>8 d深部感染发生率为0。Logistic多因素回归分析显示:年龄、糖尿病、术后并发症是影响骨折愈合的因素(P<0.05)。结论:膝前后联合入路单或双钢板内固定治疗闭合性复杂胫骨平台骨折效果较好,5~8 d是行手术的最佳时机,年龄、糖尿病、术后并发症是影响骨折愈合的因素。

Objective:To study the optimal operation timing and selection of operative approach for closed complex tibial plateau fractures,and to observe the factors that affect the healing of fracture,to provide the basis for clinical diagnosis and treatment.Method:A total of 130 cases of closed complex tibial plateau fractures treated in our hospital from June 2015 to July 2016 were selected,they were divided into groupⅠ(32 cases of knee anterior lateral single incision single plate internal fixation),groupⅡ(33 cases of internal and external incision double plate fixation),groupⅢ(36 cases of knee are straight incision double plate fixation),groupⅣ(9 cases of knee joint before and after into single or double plate fixation),groupⅤ(20 cases of small incision or closed reduction and external fixation)according to the surgical approach,the amount of operation,incision infection,internal fixation failure,fracture healing time,joint function of each group were compared,the incidence rate of delayed healing,skin ischemic necrosis,superficial infection and deep infection of different operation opportunity were observed,application of Logistic multi factor regression analysis on the factors influencing fracture healing.Result:The amount of bleeding was the least in groupⅤ,the amount of bleeding in groupⅣwas the most.GroupⅣwithout incision infection,the rate of incision infection was the highest in groupⅤ.groupⅣwithout internal fixation failure,the internal fixation failure rate of groupⅤwas the highest;the shortest healing time of groupⅣ,the length of fracture healing was the longest in groupⅠ.The excellent rate of joint function in groupⅣwas the highest,it was 100%,the excellent rate of joint function was lowest in groupⅤ.No delayed healing and skin necrosis occurred in 5-8 d,the incidence of superficial infection was the lowest in 7-8 d,7-8 d and>8 d of deep infection incidence rate was 0.Logistic multi factor regression analysis showed that:age,diabetes mellitus,and postoperative complications were the factors that influenced the fracture healing(P<0.05).Conclusion:Single or double knee combined anterior and posterior plate fixation in the treatment of closed fractures of tibial plateau complex effect,5-8 d is the best time to do surgery,age,diabetes mellitus,and postoperative complications are the factors that affect the healing of fractures.