早期应用跨关节外固定支架减轻SchatzkerⅥ型胫骨平台骨折周围软组织损伤的临床研究

Clinical study on early application of transarticular external fixation to relieve soft tissue injury around SchatzkerⅥtype tibial plateau fracture

目的探讨早期应用跨关节外固定支架对SchatzkerⅥ型胫骨平台骨折周围软组织损伤的影响。方法回顾性分析2017年7月—2019年6月在南京医科大学第一附属医院骨科就诊的SchatzkerⅥ型胫骨平台骨折患者57例,男性44例,女性13例;年龄21~56岁,平均40.4岁。患者I期均行跨关节外固定支架置入,按I期支架置入时间不同分为急诊早期(12h内)置入组(早期组,28例)和延期(24~72h)置入组(延期组,29例);待7~14d软组织损伤情况明显好转,行II期内固定手术处理。比较两组患者的治疗前后一般情况、软组织损伤变化和最终膝关节功能美国特种外科医院(HSS)膝关节评分。结果患者均获得12~18个月随访,平均12.6个月。早期组患者在I期和II期治疗手术时间、I期治疗术后视觉模拟评分(VAS)、II期治疗术中出血、术后康复时间、骨折愈合时间、住院费用均优于延期组,差异有统计学意义(P<0.05)。在术后下肢静脉血栓形成方面,两组比较差异有统计学意义(P=0.043)。两组术后其余并发症比较差异无统计学意义(P=0.317)。在软组织损伤评价方面(I期治疗术后张力性水疱、血性水疱、肿胀程度、出现皮肤皱褶时间,水疱痂皮愈合时间等),早期组显著优于延期组,差异有统计学意义(P<0.05)。最终膝关节功能HSS评分,两组比较差异无统计学意义(P=0.612)。结论对于SchatzkerⅥ型胫骨平台骨折,急诊早期12h内置入跨关节外固定支架,可以最大限度地维持复位、长度和力线,保护膝关节软组织,避免软组织继发性损伤,便于II期内固定手术,值得临床推广。

Objective To explore the effect of early application of transarticular external fixator on soft tissue injury around Schatzker VI tibial plateau fracture.Methods A total of 57 patients with Schatzker VI tibial plateau fractures were recruited from Jul.2017 to Jun.2019 in the First Affiliated Hospital of Nanjing Medical University(Jiangsu Province Hospital)retrospectively.There were 44 males and 13 females,aged from 21 to 56 years,with an average of 40.4 years.All patients were treated by transarticular external fixation in stage I and were divided into group A(28 cases)and group B(29 cases).Early application of transarticular external fixation within 12 hours was performed in group A.Delayed application of transarticular external fixation within 24-72 hours was performed in group B.After 7 to 14 days,the soft tissue injury was significantly improved,and the fixed operation of stage II was performed.The general situation,variation of soft tissue injury and hospital for special surgery(HSS)score of knee joint before and after treatment were compared between the two groups.Results All patients were followed up for an average of 12.6(12-18)months.The operation time of Stage I and Stage II,visual analogue scale(VAS)after Stage I treatment,intraoperative bleeding of Stage II,postoperative rehabilitation time,fracture healing time and hospitalization cost of patients in Group A were better than those in Group B,with statistical significances(P<0.05).Significant difference was found between the two groups in venous thrombosis of lower limbs(P=0.043).There was no significant difference in other postoperative complications between the two groups(P=0.317).In soft tissue injury evaluation(tension blisters after Stage I treatment;bloody blisters after Stage I treatment;swelling degree after stage I treatment;time of skin wrinkle after stage I treatment;healing time of blister scab),group A was significantly better than group B(P<0.05).The final HSS of knee joint were not significantly different between the two groups(P=0.612).Conclusion For Schatzker VI tibial plateau fracture,early application of transarticular external fixation within 12 hours can maintain the reduction,length and force lines,protect the soft tissue around knee joint,reduce secondary soft tissue injury,promote recovery of soft tissue,facilitate Stage II internal fixation operation and improve the clinical efficacy,which is worthy of clinical promotion.