倒"L"入路治疗胫骨平台后柱骨折的疗效分析及随访研究

Analysis of the Therapeutic Effect and Follow-up Study of Inverted"L"Approach in the Treatment of Posterolateral Tibial Plateau Fractures

目的:探讨倒"L"入路治疗胫骨平台后柱骨折的疗效、安全性及对膝关节功能的影响。方法:纳入2015年8月至2019年12月在我院骨科接受手术治疗的88例闭合性胫骨平台后柱骨折患者,随机平均分为观察组和对照组各44例。观察组采用倒"L"入路术式进行切开复位内固定治疗,对照组采用常规手术入路进行内固定治疗。比较两组患者手术时间、术中出血量、术后住院时间、骨折愈合时间、延迟愈合比例。比较两组患者膝关节功能及并发症情况。结果:观察组手术时间短于对照组(P<0.05),两组患者术中出血量、术后住院时间比较无统计学意义(P>0.05)。两组患者在愈合时间、延迟愈合比例方面比较无统计学差异(P>0.05)。观察组膝关节HSS评分、Lysholm评分及IKDC评分均高于对照组,差异具有统计学意义(P<0.05)。两组术后并发症发生率比较差异无统计学意义(P>0.05)。结论:对于胫骨平台后柱骨折的患者,采用倒"L"入路是一种新型的可靠入路方式,与传统术式相比,其对膝关节功能改善更佳,安全可靠。

Objective:To investigate the effect,safety and influence on knee joint function of posterolateral tibial plateau fractures treated by inverted"L"approach.Methods:A total of 88 patients with closed tibial plateau posterior column fractures who underwent surgical treatment in the orthopedics department of our hospital from August 2015 to December 2019 were randomly divided into observation group and control group with 44 cases each.The observation group was treated with open reduction and internal fixation using inverted"L"approach,and the control group was treated with conventional surgical approach for internal fixation.The operation time,intraoperative blood loss,postoperative hospital stay,fracture healing time,and delayed healing ratio were compared between the two groups.The knee joint function and complications were compared between the two groups.Results:The operation time of the observation group was shorter than that of the control group(P<0.05),and there was no significant difference in the intraoperative blood loss and postoperative hospital stay between the two groups(P>0.05).There was no statistical difference between the two groups in healing time and delayed healing ratio(P>0.05).The HSS score,Lysholm score and IKDC score of the observation group were higher than those of the control group,and the difference was statistically significant(P<0.05).There was no significant difference in the incidence of postoperative complications between the two groups(P>0.05).Conclusion:For patients with posterolateral tibial plateau fractures,the inverted"L"approach is a new and reliable approach.Compared with the traditional operation,it improves the knee joint function better,and is safe and reliable.