双切口双钢板内固定治疗复杂胫骨平台骨折的疗效及对患肢负重时间的影响

Therapeutic effect of double-plate internal fixation with dual-incision for the treatment of complex tibial plateau fractures and its effect on the weight bearing time of the affected limb

目的探讨双切口双钢板内固定治疗复杂胫骨平台骨折的疗效及对患肢负重时间的影响。方法选取2010年1月至2018年3月期间江门市蓬江区中西医结合医院收治的50例复杂胫骨平台骨折患者为研究对象,采用随机数法将其分为对照组和观察组各25例,对照组采用膝前正中直切口双钢板固定术治疗,观察组采用膝内外侧双切口双钢板内固定术治疗,比较两组患者的手术相关指标、术后骨折愈合时间、患肢负重时间及术后1年Merchant评分。手术后1年,采用功能性步行分级(FAC)和简式Fugl-Meyer运动功能评分法对下肢功能进行评分。结果观察组患者手术时间为(40.22±11.35) min,少于对照组的(62.35±10.13) min,术中出血量为(222.17±22.69) mL,少于对照组的(259.32±20.50) mL,差异有统计学意义(P<0.05);术后,观察组和对照组患者的骨折愈合时间[(10.21±0.64)周vs (11.39±0.98)周]、患肢负重时间[(4.90±1.05)周vs (6.11±0.93)周]比较,观察组均较对照组缩短,差异均有统计学意义(P<0.05);术后1年,观察组患者疗效评定优良率为88.0%,高于对照组的72.0%,差异有统计学意义(P<0.05);治疗前两组的功能性步行分级和简式FMA下肢运动评价量表评分比较差异均无统计学意义(P>0.05),但治疗后观察组患者的FAC评分和FMA评分分别为(5.53±0.20)分和(23.45±2.95)分,多于对照组的(3.49±0.11)分和(20.03±3.06)分,差异有统计学意义(P<0.05)。结论膝内外侧双切口双钢板内固定术可有效缩短复杂胫骨平台骨折患者患肢负重时间、骨折愈合时间,有较好的临床治疗效果。

Objective To investigate the effect of double-plate internal fixation with dual-incision for the treatment of complex tibial plateau fractures and its effect on the weight bearing time of the affected limb. Methods A total of 50 patients with complicated tibial plateau fractures admitted to the Integrated Traditional Chinese and Western Medicine Hospital of Pengjiang District of Jiangmen City from January 2010 to March 2018 were selected as subjects and randomly divided into control group (n=25) and observation group (n=25) by random number table method. The control group was treated with double-plate fixation with an anterior midline knee incision, while the observation group was treated with double-plate internal fixation with internal and external dual-incision. Surgical related indexes, postoperative fracture healing time, weight bearing time of the affected limb, and postoperative Merchant score at 1 year after surgery were compared between the two groups. One year after surgery, the lower limb function was scored using functional ambulation categories (FAC) and the simplified Fugl-Meyer assessment (FMA) scale. Results The operation time was less in observation group than in control group:(40.22±11.35) min vs (62.35±10.13) min, and the intraoperative bleeding volume was less in observation group than in control group (222.17±22.69) mL vs (259.32±20.50) mL;both differences were statistically significant (P<0.05). After operation, comparison between observation group and control group on the healing time of fracture and the weight-bearing time of affected limbs showed that both times in observation group were shorter than those in control group (P<0.05):(10.21±0.64) weeks vs (11.39±0.98) weeks,(4.90± 1.05) weeks vs (6.11±0.93) weeks. One year after operation, the excellent and good rate was higher in observation group than in control group (88.00% vs 72.00%, P<0.05). Before treatment, there was no statistically significant difference in FAC grading and simplified FMA scoring between the two groups (P>0.05);while after treatment, the FAC grading and simplified FMA scoring were higher in observation group than in control group: FAC score:(5.53±0.20) vs (3.49±0.11);FMA score:(23.45±2.95) vs (20.03±3.06);P<0.05. Conclusion Double-plate internal fixation with internal and external dual-incision can effectively shorten the weight-bearing time of the affected limb and the fracture healing time in patients with complex tibial plateau fractures, and have better clinical effect.