复杂胫骨平台骨折双切口双钢板内固定术的疗效

Effect of double incision double plates internal fixation on complex tibia plateau fractures

目的探讨复杂胫骨平台骨折患者进行膝关节内外侧双切口双钢板复位内固定术治疗的临床疗效。方法选取2016年2月至2018年5月泰兴市第二人民医院收治的均符合复杂胫骨平台骨折诊断标准、且不存在其他部位骨折的患者64例为研究对象。根据手术方式的不同分为研究组(29例)和对照组(35例),其中对照组患者给予单侧锁定钢板内固定术治疗,研究组患者给予膝关节内外侧双切口双钢板复位内固定术治疗。分别采用卡方检验和t检验对两组患者术后恢复优良率、手术相关指标及术后愈合时间进行统计分析,并对比术后6个月及1年Rasmussen膝关节评分、胫骨平台后倾角度数及胫骨平台内翻角度数,并观察两组患者并发症发生情况。结果研究组患者的优良率显著较对照组升高(2=12.874,P<0.05);研究组与对照组患者术中出血量、手术时间、切口长度对比无显著差异(P>0.05),研究组患者的骨折愈合时间、开始下地负重时间及开始锻炼时间显著较对照组缩短(t=8.327、10.528、13.539,均为P<0.05)。术后6个月及术后1年,研究组患者的Rasmussen膝关节评分显著高于对照组(t=7.04、6.60,均为P<0.05);术后1年,对照组患者胫骨平台后倾角及内翻角度数显著高于研究组(t=-2.22、-7.63,均为P<0.05);研究组患者的并发症总发生率显著低于对照组(t=10.326,P<0.05)。结论复杂胫骨平台骨折患者进行膝关节内外侧双切口双钢板复位内固定术治疗疗效显著,能够有效促进患者恢复,降低术后并发症,值得临床推广。

Objective To investigate the clinical effect of double incision double plate reduction and internal fixation on the internal and external sides of knee joint in patients with complex tibia plateau fracture.Methods From February 2016 to may 2018,64 patients who met the diagnostic criteria of complex tibial plateau fractures and did not have fractures in other parts were selected.According to the different operation methods,they were divided into the study group(29 cases)and the control group(35 cases).The patients in the control group were treated with unilateral locking plate internal fixation,while the patients in the study group were treated with knee joint internal fixation.The follow-up observation was carried out at six months and one year after the operation.Chi-square test was used to analyze the excellent and good rate of postoperative recovery and the complications,operation related indexes,postoperative healing time,Rasmussen knee joint score,tibial plateau angulation degree and tibial plateau angulation degree of the two groups were compared by t test.Results The excellent rate of the patients in the study group was significantly higher than that in the control group(2=12.874,P<0.05).There was no significant difference between the study group and the control group in the amount of intraoperative bleeding,operation time or incision length(P>0.05).The fracture healing time,the time of starting weight-bearing and the time of starting exercise of the study group were significantly shorter than the control group(t=8.327,10.528,13.539,P<0.05).Six months and one year after operation,the Rasmussen knee joint score of the study group was significantly higher than the control group(t=7.04,6.60,P<0.05).One year later,the tibial plateau caster angle and the degree of varus angle in the control group were significantly higher than that in the study group(t=-2.22,-7.63,P<0.05).The total incidence of complications in the study group was significantly lower than that in the control group(t=10.326,P<0.05).Conclusion The effect of double-incision double plates internal fixation on the internal and external sides of knee joint is remarkable in complex tibia plateau fractures,which can effectively promote the recovery and reduce postoperative complications,and is worthy of clinical application.