术前临时外固定架处理在复杂胫骨平台骨折内固定术中的临床应用

The role of temporary external fixation prior to the internal fixation of complex tibial plateau fractures

目的探讨术前临时外固定架处理与跟骨牵引在复杂胫骨平台骨折内固定术中的临床应用。方法选取2020年1月—2020年12月哈尔滨医科大学附属第一医院收治的104例复杂胫骨平台骨折患者作为研究对象。根据不同的手术方式将患者分为外固定组(55例)和牵引组(49例)。两组患者均进行复杂胫骨平台骨折内固定术治疗,外固定组术前予以临床外固定架处理,牵引组术前予以跟骨牵引处理。对两组患者手术情况、术后并发症发生率、手术效果、随访情况等进行比较。结果外固定组接诊至内固定术时间、手术时间、住院时间较牵引组短(P<0.05),术中出血量较牵引组少(P<0.05)。外固定组术后并发症总发生率低于牵引组(P<0.05)。外固定组术后手术优良率高于牵引组(P<0.05)。外固定组骨折愈合时间短于牵引组(P<0.05),膝关节活动度大于牵引组(P<0.05),HSS膝关节评分高于牵引组(P<0.05)。结论复杂胫骨平台骨折患者在内固定术治疗前予以临时外固定架,能进一步提高患者的手术效果,降低术前等待和术中操作时间,提高手术效果和安全性,促进患者骨折愈合及获得良好的预后,值得临床推荐。

Objective To compare the clinical effect of temporary external fixation and calcaneus traction prior to the internal fixation of complex tibial plateau fractures.Methods A total of 104 patients with complex tibial plateau fractures admitted to our hospital from January to December 2020 were selected and divided into external fixation group(55 cases)and traction group(49 cases).Both groups were treated with internal fixation of complex tibial plateau fractures.Before the internal fixation,the external fixation group was treated with external fixators,while the traction group was treated with calcaneus traction.The stime from admission to internal fixation,operative duration,length of hospital stay postoperative,complication rate,operative outcome and follow-up indicators were compared between the groups.Results The time from admission to internal fixation,operative duration,and length of hospital stay were shorter,and the amount of intraoperative bleeding was smaller in the external fixation group relative to the traction group(P<0.05).The overall incidence of postoperative complications in the external fixation group was lower than that in the traction group(P<0.05).The excellent and good rate of external fixation group was higher than that of traction group(P<0.05).During the outpatient follow-up,the fracture healing time was shorter,the range of motion of the knee joint was greater,and Hospital for Special Surgery(HSS)score was higher in the external fixation group compared with the traction group(P<0.05).Conclusions For patients with complex tibial plateau fractures,temporary external fixation prior to internal fixation can further improve the operative outcome and patient safety,reduce the preoperative waiting time and operative duration,promote the fracture healing and contribute to good prognosis,and it could be therefore recommended in clinical practice.