后侧倒L入路联合前外侧入路三钢板固定胫骨平台三柱骨折的临床疗效

Clinical effect of posterior inverted L-shaped approach and anterolateral approach combined with three-plate fixation on patients with three-column fracture of tibial plateau

目的探讨后侧倒L入路联合前外侧入路三钢板固定对胫骨平台三柱骨折术后复位质量和膝关节功能的影响。方法回顾性分析在我院接受治疗的76例胫骨平台三柱骨折患者的临床资料,依据手术方式分为对照组和观察组。对照组39例患者行前外侧联合后内侧入路双钢板固定,观察组37例患者行后侧倒L入路联合前外侧入路三钢板固定。比较2组患者手术时间、术中出血量、膝关节锻炼时间、住院时间、骨折愈合时间、完全负重时间、内翻角(TPA)、后倾角(PSA)、膝关节功能优良率、术后并发症、美国纽约特种外科医院(HSS)评分和36条目健康调查量表(SF-36)评分。结果2组患者手术时间、术中出血量、膝关节锻炼时间、住院时间、HSS评分及SF-36评分比较,差异均有统计学意义(P<0.05);2组患者骨折愈合时间和完全负重时间比较,差异无统计学意义(P>0.05)。与术后即刻比较,2组患者术后12个月PSA均更大、TPA均更小(P<0.05);观察组患者术后即刻TPA大于对照组(P<0.05),2组患者术后即刻PSA及术后12个月TPA、PSA比较,差异无统计学意义(P>0.05)。观察组患者术后12个月膝关节功能优良率高于对照组(P<0.05)。2组术后并发症发生率比较,差异无统计学意义(P>0.05)。结论相较于前外侧联合后内侧入路双钢板固定,后侧倒L入路联合前外侧入路三钢板固定治疗胫骨平台三柱骨折虽手术过程复杂,术中出血量多,但该术式可使患者尽快进行膝关节锻炼,一定程度上提高了复位质量,有利于膝关节功能的恢复。

Objective To explore the effect of posterior inverted L-shaped approach and anterolateral approach combined with three-plate fixation on the quality of fracture reduction and knee function of patients with three-column fracture of tibial plateau.Methods The clinical data of 76 patients with three-column tibial plateau fractures in our hospital were retrospectively analyzed.According to the operation method,they were divided into the observation group and the control group.Thirty-nine patients in the control group underwent anterolateral and postero-medial approach combined with double plate fixation,and 37 patients in the observation group underwent posterior inverted L-shaped approach and anterolateral approach combined with three-plate fixation.The operation time,intraoperative blood loss,knee functional rehabilitation exercise time,hospitalization time,fracture healing time,full weight bearing time,tibial plateau varus angle(TPA),posterior sloping angle(PSA),excellent and good rate of knee joint function,postoperative complications,New York Special Surgery Hospital(HSS)and 36 item health survey scale(SF-36)of the two groups were compared.Results There were statistically significant differences in the operation time,intraoperative blood loss,knee functional rehabilitation exercise time,hospitalization time,HSS and SF-36 scores between the two groups(P<0.05).There was no statistically significant difference in fracture healing time and full weight bearing time between the two groups(P>0.05).Compared with immediately after operation,the PSA of the patients in the two groups was larger and the TPA was smaller 12 months after the operation(P<0.05).The TPA of the observation group was larger than that of the control group immediately after the operation(P<0.05).There was no statistically significant difference in immediate PSA,TPA and PSA 12 months after surgery between the two groups(P>0.05).The excellent and good rate of knee joint function in the observation group was higher than that in the control group 12 months after surgery(P<0.05).There was no significant difference in the incidence of postoperative complications between the two groups(P>0.05).Conclusion Compared with anterolateral and postero-medial approach combined with double plate fixation,the posterior inverted L-shaped approach and anterolateral approach combined with three-plate fixation for the treatment of three-column tibial plateau fracture is complicated with more intraoperative blood loss,but it can promote the patients to take functional rehabilitation exercise of knee joint as early as possible and improve the reduction quality to some extent,which is beneficial to the recovery of knee joint function.