前正中入路双钢板固定在Schatzker分型Ⅴ、Ⅵ型胫骨平台骨折中的研究应用

Research of double plate fixation through anterior median approach in tibial plateau fractures of Schatzker typeⅤandⅥ

目的 探讨前正中入路双钢板固定在Schatzker分型Ⅴ、Ⅵ型胫骨平台骨折中的临床应用。方法 选取2015年3月~2018年5月收治的60例SchatzkerⅤ、Ⅵ型胫骨平台骨折患者,以随机数表法分为观察组和对照组各30例。观察组行膝前正中入路联合双钢板固定治疗,对照组行膝内外侧切口联合双钢板治疗。记录两组的手术时间、术中出血量、切口愈合时间、并发症发生情况;于治疗后12个月,以HSS评分系统评估膝关节功能恢复情况,并以X线片测量胫骨近端内侧角(MPTA)、胫骨近端后角(PPTA)数据。结果 观察组的手术时间、术中出血量显著低于对照组(<0.05);而观察组的切口愈合时间与对照组相比,差异无统计学意义(>0.05)。观察组的并发症发生情况,切口皮肤坏死、切口感染、骨折再塌陷均少于对照组,但骨折愈合延迟较对照组高;观察组的并发症发生率(20.00%)稍低于对照组(26.67%),但差异无统计学意义(>0.05)。观察组患者的优良率(83.33%)优于对照组(60.00%)(=4.022,=0.045)。治疗后,两组患者的MPTA、PPTA差异无统计学意义(>0.05)。术后7 d X线片显示,对照组患者双钢板固定在位,骨折复位比较理想;观察组患者的胫骨平台内固定后关节面平整,骨愈合良好。全部患者均获随访,随访结果显示患者伤口愈合良好。结论 前正中切口入路双钢板固定治疗对于Schatzker分型Ⅴ、Ⅵ型胫骨平台骨折是一种安全、有效的手术方式,有助于患者的膝关节功能恢复。

Objective To explore the value of double plate fixation through anterior median approach in tibial plateau fractures of Schatzker typeⅤandⅥ.Methods A total of 60 patients with Schatzker typeⅤandⅥtibial plateau fractures who were admitted to the hospital from March 2015 to May 2018 were enrolled.They were divided into observation group(knee anterior median approach combined with double plate fixation)and control group(knee medial and lateral incision approach combined with double plate fixation)by random number table method,30 cases in each group.The operation time,intraoperative blood loss,incision healing time and occurrence of complications in both groups were recorded.After 12 months of treatment,HSS scoring system was applied to evaluate recovery of knee function.The medial proximal tibial angle(MPTA)and posterior proximal tibial angle(PPTA)were measured by X-ray films.Results The operation time and intraoperative blood loss of observation group were significantly lower than those of control group(P<0.05).There was no significant difference in incision healing time between the two groups(P>0.05).The incidence of complications such as incision skin necrosis,incision infection and fracture re-collapse in observation group was lower than that in control group,while fracture healing delay was higher than that in control group.The incidence of complications in observation group was slightly lower than that in control group(20.00%vs.26.67%)(P>0.05).The good rate of observation group was better than that of control group(83.33%vs.60.00%)(t=4.022,P=0.045).After treatment,there was no significant difference in MPTA or PPTA between the two groups(P>0.05).At 7 d after surgery,X-ray showed that double plate fixation was in place,and fracture reduction was ideal in control group.The articular surfaces were smooth after internal fixation of tibial plateau,and bones healing was good in observation group.All patients were followed up,and the follow-up results showed that the wound healing was good.Conclusion The anterior median incision approach combined with double plate fixation is a safe and effective surgical procedure for tibial plateau fractures of Schatzker type V and VI,which is beneficial to the recovery of knee function.