胫骨平台骨折合并软组织损伤的诊断与治疗

Diagnosis and Treatment of Tibial Plateau Fracture with Soft Tissue Injury

背景胫骨平台骨折常合并膝关节周围软组织损伤,如果在正确、及时治疗胫骨平台骨折的基础上,对其合并的软组织损伤早期诊断、治疗,不仅可以帮助患者减轻痛苦,还可以最大限度帮助患者恢复患肢功能,提高其生活质量。目的探讨胫骨平台骨折合并软组织损伤诊断和治疗的策略。方法选择2014年4月-2017年9月在山西医科大学第二医院住院治疗的胫骨平台骨折合并软组织损伤患者82例为研究对象,并根据Schatzker分型情况分为6种类型。记录患者术前一般资料、围术期指标、软组织损伤分布情况及多处软组织损伤情况,并进行比较。结果本次调查患者延迟诊断及漏诊的发生率为30.5%(25/82)。Ⅲ、Ⅴ、Ⅵ型骨折的手术时长多于Ⅰ、Ⅱ、Ⅳ型骨折,Ⅵ型骨折的出血量多于Ⅰ、Ⅱ、Ⅲ、Ⅳ、Ⅴ型骨折(P<0.05)。40例患者发生多处(2处及以上)软组织损伤,Ⅰ、Ⅱ、Ⅲ、Ⅳ、Ⅴ、Ⅵ型多处软组织损伤率比较,差异无统计学意义(P=0.574)。患者均在术后4~8个月骨性愈合,下肢力线基本正常。美国特种外科医院膝关节评分(HSS评分):26例为优,29例为良,26例为可,1例为差,优良率为67.1%。结论胫骨平台骨折合并软组织损伤延迟诊断及漏诊率较高,要给予高度重视,早期诊断、早期治疗软组织损伤,尽量避免造成患肢运动、感觉障碍,甚至截肢的严重后果。

Background Tibial plateau fracture is often associated with soft tissue injury around knee joint.Early diagnosis and treatment of tibial plateau fracture combined with soft tissue injury on the basis of correct and timely treatment can not only help patients alleviate pain,but also help patients recover limb function to the greatest extent and improve their quality of life.Objective To explore the strategy of diagnosis and treatment of tibial plateau fracture with soft tissue injury.Methods A total of 82 patients with tibial plateau fracture and soft tissue injury who were hospitalized in the Second Hospital of Shanxi Medical University from April 2014 to September 2017 were selected as the study subjects,and were divided into six groups according to Schatzker classification.The preoperative general data,perioperative indicators,soft tissue injury distribution and multiple soft tissue injuries were recorded and compared.Results The incidence of delayed diagnosis and missed diagnosis was 30.5%(25/82).The operation time of types Ⅲ,Ⅴ and Ⅵ fracture was longer than that of types Ⅰ,Ⅱ and Ⅳ fracture,and the bleeding volume of type Ⅵ fracture was more than that of types Ⅰ,Ⅱ,Ⅲ,Ⅳ and Ⅴ fracture(P<0.05).There were 40 cases with multiple soft tissue injuries(2 or more),and there was no significant difference in the rate of multiple soft tissue injuries(P=0.574)between Schatzker types Ⅰ,Ⅱ,Ⅲ,Ⅳ,Ⅴ and Ⅵ.Bone healing occurred 4 to 8 months after operation,and line of gravity of lower limbs was basically normal.Knee Joint Score of Hospital for Special Surgery(HSS):26 cases were excellent,29 cases were good,26 cases were acceptable,1 case was poor,with the excellent and good rate was 67.1%.Conclusion The delayed diagnosis and missed diagnosis rate of tibial plateau fracture complicated with soft tissue injury is high.Great attention should be paid to early diagnosis and treatment of soft tissue injury,so as to avoid serious consequences such as limb movement,sensory disturbance and even amputation.