复杂胫骨平台骨折手术时机与手术方式对疗效的影响

Effect of Surgery Time and Surgical Method on the Curative Effect of Complex Tibial Plateau Fractures

目的:研究复杂胫骨平台骨折的手术时机与手术方式的选择。方法:对2014年4月至2017年4月我院收治的60例复杂胫骨平台骨折手术患者进行回顾性分析,根据手术方式的不同分为4组,A组为小切口或闭合复位,外固定;B组为膝前切口,双钢板固定;C组为膝内外双侧切口,双钢板固定;D组为膝外侧单切口,单钢板固定。观察所有患者发生术后并发症的情况,并按照不同手术时机(发病至手术间隔时间)进行分析对比。对所有患者随访12个月,记录4组发生骨折延迟愈合、内固定失败、膝关节不稳、创伤性骨关节炎等远期并发症的情况,并采用HSS评分对所有患者的膝关节功能进行评价。结果:随着时间增长,并发症发生率逐渐降低,发病至手术间隔6~8 d的并发症发生率最低(0.00%),8 d后的并发症发生率再次升高。A、B、C、D 4组远期并发症发生率分别为36.36%、21.05%、18.75%及42.86%,差异无统计学意义(P>0.05),4组HSS评分优良率分别为54.55%、94.74%、87.50%及78.57%,其中,B组优良率高于A组(P<0.05)。结论:对于复杂胫骨平台骨折,伤后6~8 d进行手术为最佳时机,术后并发症最少,各项手术方式各有优劣,可根据情况进行选择。

Objective:To investigate the surgery time and surgical method of complex tibial plateau fractures.Methods:A total of 60 cases of patients with complex tibial plateau fractures from Apr 2014 to Apr 2017 in our hospital were enrolled,and were divided into 4 groups according to the different surgical method.Group A received the small incision or closed reduction and external fixation.Group B received anterior knee incision and double plate fixation.Group C received bilateral knee incision and double plate fixation.Group D received knee lateral incision and single plate fixation.The postoperative complications and the surgery time(from onset to surgery)were comparatively analyzed.All patients were followed up for 12 months,and the long-term complications include fracture delayed union,internal fixation failure,knee instability and traumatic arthritis were recorded.HSS score was used to evaluate the function of knee joint.Results:With the increase of surgery time,the incidence of complications gradually decreased after injury,with the lowest incidence in 6-8 d,while the incidence of complications increased again after 8 d.The incidence of longterm complications in groups A,B,C and D were 36.36%,21.05%,18.75%and 42.86%respectively,and the difference was not statistically significant(P>0.05).The excellent rates of HSS scores in the four groups were 54.55%,94.74%,87.50%and 78.57%respectively.The excellent rate in group B was significantly higher than that in group A(P<0.05).Conclusions:For complex tibial plateau fractures,the best time for surgery is 6 to 8 d after injury with the least postoperative complications.The surgical methods have their own advantages and disadvantages,which can be selected according to the situation.