中老年胫骨内侧平台骨折患者行有限切开复位内固定腓骨段植骨术治疗效果观察

Effect of limited open reduction and internal fixation of fibula segment bone graft on medial tibial plateau fracture in middle-aged and elderly patients

目的比较有限切开复位内固定腓骨段植骨术与切开复位内固定髂骨段植骨术治疗中老年胫骨内侧平台骨折的疗效及安全性。方法中老年胫骨内侧平台骨折患者104例,随机分为观察组和对照组各52例,分别行有限切开复位内固定腓骨段植骨术、切开复位内固定髂骨段植骨术治疗。评价2组术后6个月膝关节功能优良率;采用视觉模拟评分(visual analogue scale,VAS)评价2组术前1d及术后1个月膝关节疼痛程度;采用Fcmandez-Cslcvc骨痂形成评分评价2组术后3个月骨折愈合情况;比较2组术后1个月并发症发生率。结果术后6个月观察组膝关节功能优良率(76.92%)高于对照组(53.85%)(P<0.05)。术后1个月观察组、对照组膝关节VAS[(2.37±1.63)、(5.69±1.76)分]均低于术前[(7.42±2.03)、(7.59±1.98)分](P<0.05),观察组低于对照组(P<0.05)。术后3个月观察组Fcmandez-Cslcvc骨痂形成评分[(3.90±0.76)分]高于对照组[(2.68±0.53)分](P<0.05)。术后1个月观察组感染、下肢静脉血栓、皮肤坏死、平台塌陷发生率(0、0、0、1.92%)低于对照组(5.77%、1.92%、3.85%、5.77%)(P<0.05)。结论与切开复位内固定髂骨段植骨术比较,有限切开复位内固定腓骨段植骨术治疗中老年胫骨内侧平台骨折可明显减轻膝关节疼痛,改善膝关节功能,降低术后并发症发生率。

Objective To compare the surgical outcome and safety of limited open reduction and internal fixation of fibula segment bone graft versus open reduction and internal fixation of the iliac bone graft in the treatment of medial tibial plateau fractures in the middle-aged and elderly patients.Methods Totally 104middle-aged and elderly patients with medial tibial plateau fractures were randomly and equally divided into observation group(receiving open reduction and internal fixation of fibula segment bone grafting)and control group receiving open reduction and internal fixation of iliac segment bone grafting.The excellent and good rate of knee joint function was evaluated in two groups six months after operation.The visual analogue scale(VAS)was used to evaluate the knee pain degree one day before and one month after operation.The Fcmandez-Cslcvc callus formation score was used to evaluate the fracture union three months after operation.The incidence of complications one month after operation was compared between two groups.Results The excellent and good rate of knee joint function was higher in observation group(76.92%)than that in control group(53.85%)six months after operation(P<0.05).The VAS scores were lower one month after operation(2.37±1.63,5.69±1.76)than those before operation(7.42±2.03,7.59±1.98)in observation group and control group(P<0.05),and the VAS score was lower in observation group than that in control group(P<0.05).The Fcmandez-Cslcvc callus formation score was higher in observation group(3.90±0.76)than that in control group(2.68±0.53)three months after operation(P<0.05).The incidences of infection,lower limb venous thrombosis,skin necrosis and plateau collapse were lower in observation group(0,0,0,1.92%)than those in control group(5.77%,1.92%,3.85%,5.77%)one month after operation(P<0.05).Conclusion Compared with open reduction and internal fixation of iliac bone graft,limited open reduction and internal fixation of fibula bone graft can obviously alleviate knee pain,improve knee joint function,and reduce postoperative complications in the treatment of medial tibial plateau fractures in middle-aged and elderly patients.