不同入路下胫骨平台前外侧柱并发后外侧柱骨折患者的手术效果对比

Comparison of surgical outcomes of anterolateral tibial plateau fractures combined with poster lateral column fractures under different approaches

目的:探索外侧单切口双间隙入路、前外联合后外双切口入路、腓骨颈截骨入路治疗胫骨平台前外侧柱并发后外侧柱骨折患者的手术效果.方法:选取2014年12月~2017年12月于我院接受治疗的96例患者为研究对象,按照随机数表法将患者分为外侧单切口组,前外联合组和腓骨颈截骨组,每组32例.外侧单切口组应用外侧单切口双间隙入路治疗,前外联合组应用前外联合后外双切口入路治疗,腓骨颈截骨组应用腓骨颈截骨入路治疗.记录三组患者手术时间、切口长度、术中出血量及术后住院时间,采用Rasmussen评价量表对患者术后骨折恢复情况进行评价,采用改良美国特种外科医院评价量表(HSS)对手术前后患者膝关节功能进行评定.结果:外侧单切口组手术时间(79.35±19.63)min比前外联合组(90.17±21.47)min和腓骨颈截骨组(106.98±25.19)min短,前外联合组切口长度(10.13±2.65)cm和术中出血量(151.39±26.84)mL比外侧单切口组(17.46±3.47)cm、(208.47±34.17)mL和腓骨颈截骨组(16.28±3.58)cm、(264.18±35.66)mL少,数据对比具有统计学差异,三组患者术后住院时间无统计学差异.腓骨颈截骨组术后骨折复位优良率为81.25%,显著高于外侧单切口组68.75%和前外联合组71.88%.三组胫骨平台前外侧柱并发后外侧柱骨折患者术后HSS评分均较术前评分有显著上升,但三组患者数据对比不具有统计学差异.结论:外侧单切口双间隙入路手术操作相对简单,手术时间较短,前外联合后外双切口入路术中出血量及手术切口长度较短,对患者造成疼痛较少,腓骨颈截骨入路术后骨折复位效果较好,三组入路方法膝关节功能恢复效果均明显.

Objective To explore the surgical effect of the lateral single incision and double gap approach, the anterior external combined external double incision approach and the fibula neck osteotomy for the anterior lateral column of the tibial plateau with lateral column fracture. Methods 96 patients who were treated in our hospital from 2014 to 2017 were selected as the research subject, and divided into the lateral single incision group, the anterior external union group and the fibula osteotomy group, with 32 cases in each group. The lateral single incision group was treated with the lateral single incision and double gap approach, and the anterior external group was treated with the anterior external combined external double incision approach, and the fibula neck osteotomy group was treated with the fibula osteotomy approach. The operation time, the length of the incision, the amount of bleeding and the time of hospitalization were recorded in the three groups. The Rasmussen evaluation scale was used to evaluate the recovery of the patients after the operation. The modified American special surgical hospital evaluation scale (HSS) was used to evaluate the knee function of the patients before and after the operation. Results The operation time of the lateral single incision group (79.35 ± 19.63) min was shorter than that of the anterior external group (90.17 ± 21.47) min and the fibula osteotomy group (106.98 ± 25.⑼ min, the incision length (10.13 ± 2.65) cm and the intraoperative bleeding volume (151.39 ± 26.84) mL compared to the lateral single incision group (17.46 ± 3.47) cm, and (208.47 ± 90.17) mL and fibula Cervical osteotomy group (16.28 ± 3.58) cm,(264.18 ± 35.66) mL less, data comparison was statistically significant. There was no statistical difference between the three groups after operation. The excellent and good rate of fracture reduction in the fibula neck osteotomy group was 81.25%, significantly higher than that in the lateral incision group of 68.75% and the anterior external joint group of 71.88%. The HSS scores of the three groups of tibial plateau anterolateral column and poster lateral column fracture were significantly higher than those before the operation, but there was no statistical difference between the three groups. Conclusion The operation of the lateral single incision and double gap approach was relatively simple, the operation time was shorter, the amount of bleeding and the length of the incision were short,the pain was less in the patients, and the effect of the fracture reduction was better after the osteotomy of the fibula. The effect of the three groups of approach knee joint function recovery was obvious.