双反牵引复位微创内固定治疗老年SchatzkerⅣ型胫骨平台粉碎性骨折的临床疗效观察

Efficacy analysis of minimally invasive treatment for Schatzker typeⅣtibial plateau fractures using homeopathic double reverse device

目的探讨应用双反牵引复位微创植骨内固定治疗老年人SchatzkerⅣ型胫骨平台粉碎性的临床疗效。方法2017年1月—2019年8月,共有12例SchatzkerⅣ型老年胫骨平台粉碎性骨折的患者在我科接受手术治疗,采取传统的切开复位钢板内固定术;2019年9月开始至今,8例相同骨折类型的老年患者,采用双反牵引复位微创植骨内固定术。对以上病例进行回顾性分析,对两组患者的手术时间、术中出血量、切口长度、术后弃拐负重时间及术后功能恢复等各项指标进行比较,评估手术效果。记录患者术后4周、12周、24周及48周时膝关节Lysholm评分及末次随访时的Ahlback分级。结果双反牵引手术组较传统手术组,手术时间短,出血少,切口长度短,两者差异具有统计学意义(P<0.05)。所有患者术后均有随诊。双反牵引手术组的术后24周、48周的膝关节Lysholm评分与传统手术组比较,具有统计学差异(P<0.05);双反牵引手术组骨性关节炎Ahlback分级与传统手术组比较,具有统计学差异(P<0.05)。结论双反牵引复位微创植骨内固定治疗老年SchatzkerⅣ型胫骨平台粉碎性骨折具有良好的临床疗效。

Objective To evaluate the clinical effectiveness of homeopathic double reverse device in minimally invasive treatment for old people subjected to Schatzker typeⅣtibial plateau fractures.Methods From January 2017 to August 2019,twelve elderly patients admitted to the department of Orthopedic surgery of Yuebei People’s Hospital who suffered from SchatzkerⅣtype tibial plateau fractures received traditional open reduction and plate fixation.From September 2019 to now,eight cases of the same type of elderly patients received minimally invasive treatment with homeopathic double reverse device.The above cases were analyzed retrospectively;the treatment was evaluated according to the surgical time,blood loss,incision length and the first time of getting out of bed;and the functional outcomes were evaluated according to HHS scores and Ahlback function classification.Results All operations were performed successfully.The minimally invasion group had shorter operation time,less bleeding and shorter incision length than the open group,and the difference were statistically significant(P<0.05).There was significant difference in Lysholm scores at the 24 th and 48 th week and in Ahlback function classification at last follow-up(P<0.05).Conclusion Hameopatihic double reverse device proved to be a feasible and worthwhile alternative for elderly patient suffering from Schatzker typeⅡandⅢtibial plateau fractures.