不同固定方式治疗复杂胫骨平台骨折的疗效分析

Effect analysis of different fixation methods in the treatment of complex tibial plateau fracture

目的探讨解剖钢板内固定、双切口双钢板内固定疗法(DIDPIF)和单侧锁定钢板内固定(ULPIF)治疗复杂胫骨平台骨折的疗法。方法 2016年1月~2019年1月我院收治的复杂胫骨平台骨折病人150例。按照随机数字表法分为解剖钢板内固定组,DIDPIF组和ULPIF治疗组,每组50例。观察3组病人的临床疗效、术后并发症、膝关节功能。结果解剖钢板内固定组,DIDPIF组和ULPIF治疗组病人的手术时间[(95.43±15.16)vs(96.01±16.09)vs(95.99±15.19)] mi、术中出血量[(281.55±52.07)vs(283.59±53.11)vs(282.66±53.04)] ml及切口长度[(11.38±0.73)vs(10.97±0.44)vs(10.64±0.69)] cm比较,差异无统计学意义(P>0.05);3组病人负重时间、愈合时间及膝关节锻炼时间比较,差异有统计学意义(P<0.05);其中,ULPIF治疗组负重时间和愈合时间显著小于DIDPIF治疗组,DIDPIF治疗组膝关节锻炼时间小于ULPIF治疗组,差异有统计学意义(P<0.05);3组病人术后即刻、术后3个月、术后12个月内翻角和后倾角比较,差异有统计学意义(P<0.05);其中DIDPIF治疗组和ULPIF治疗组比较,差异无统计学意义(P>0.05);DIDPIF治疗组和ULPIF治疗组HSS评分和优良率比较,差异无统计学意义(P>0.05),但均显著高于解剖内固定治疗组,差异有统计学意义(P<0.05);DIDPIF与ULPIF治疗组术后并发症比较,差异无统计学意义(P>0.05),但均显著低于解剖钢板内固定治疗组,差异有统计学意义(P<0.05)。结论 DIDPIF与ULPIF治疗胫骨平台骨折的疗效相当,均能够获得满意的固定稳定性,优于解剖钢板内固定,且病人愈后下肢力线好,膝关节功能恢复率高,但各具优缺点,临床上需根据病人的实际情况选择手术方式。

Objective To investigate the relationship between internal fixation of anatomical plate,DIDPIF and ULPIF and the recovery of patients with complex tibial plateau fractures,the infection rate of incision and the degree of motion of knee joint.Methods A total of 150 patients with complex tibial plateau fractures were selected to be treated in our hospital from January 2016 to January 2019.According to the random number table method,the patients were divided into anatomic plate fixation group,DIDPIF treatment group and ULPIF treatment group,with 50 patients in each group.The clinical curative effect,postoperative complications,knee joint function and the three groups of patients were observed.Results There was no significant difference in operative time [(95.43±15.16)vs(96.01±16.09)vs(95.99±15.19)] min,intraoperative blood loss [(281.55±52.07)vs(283.59±53.11)vs(282.66±53.04)] ml and incision length [(11.38±0.73)vs(10.97±0.44)vs(10.64±0.69)] cm among anatomic plate fixation group,DIDPIF treatment group and ULPIF treatment group(P>0.05).There were significant differences in weight-bearing time,healing time and knee joint exercise time among the three groups(P<0.05);Among them,the load time and healing time of ULPIF treatment group were significantly lower than that of DIDPIF treatment group(P<0.05),the time of knee joint exercise in the DIDPIF treatment group was significantly less than that in the ULPIF treatment group.After operation,3 months,12 months after operation of TPA and PA were significant different among the three groups(P<0.05),while there was no significant difference between the DIDPIF treatment group and the ULPIF treatment group(P<0.05).There was no significant difference in HSS score and excellent and good rate between DIDPIF treatment group and ULPIF treatment group(P>0.05),but both of them were significantly higher than those of the anatomic internal fixation group(P<0.05).In terms of postoperative complications,there was no statistically significant difference between the DIDPIF treatment group and ULPIF treatment group,while both of them were significantly lower than anatomical plate internal fixation group(P<0.05).Conclusion The curative effect of unilateral locking plate internal fixation and double incision double plate internal fixation in the treatment of tibial plateau fracture is similar,both can obtain satisfactory fixation stability,better than anatomical plate internal fixation.In addition,the patient has a good lower limb strength line and a high recovery rate of knee joint function after recovery,but each has its advantages and disadvantages,so the operation method should be selected clinically according to the actual situation of the patient.