膝关节后外侧纵直形切口入路手术治疗后外侧胫骨平台骨折患者的效果

Effect of the Posterolateral Knee Joint Vertical Straight Incision Approach for the Patients with Posterolateral Tibial Plateau Fractures

目的探究膝关节后外侧切口(纵直形)入路手术治疗后外侧胫骨平台骨折(TPF)患者的效果。方法选取2019年1月至2021年3月汝州市第一人民医院收治的114例后外侧TPF患者,进行前瞻性随机平行对照研究,按随机数字表法分成A组(n=57)、B组(n=57)。B组接受膝关节后内侧切口(倒“L”形)入路手术治疗,A组接受膝关节后外侧切口(纵直形)入路手术治疗。对比两组总有效率、围手术期指标、术前及术后3个月胫骨平台(外侧)后倾角及膝关节屈伸活动度、术前及术后6h创伤应激因素[血清促肾上腺皮质激素(ACTH)、醛固酮(ALD)、皮质醇(Cor)]水平。结果两组手术效果对比,差异无统计学意义(P>0.05);A组术中失血量较B组少,手术时长较B组短(P<0.05);两组术后3个月胫骨平台后倾角较术前改善(P<0.05),组间对比差异无统计学意义(P>0.05);两组术后6h血清ACTH、ALD、Cor水平均较术前升高,但A组较B组低(P<0.05)。结论膝关节后内侧切口(倒“L”形)入路手术与膝关节后外侧切口(纵直形)入路手术治疗后外侧TPF患者疗效相当,均能有效改善胫骨平台后倾角,但后者于优化围手术期指标、减轻手术创伤应激方面更具优势。

Objective To explore the effect of surgical treatment of posterolateral knee joint incision(vertical straight)for patients with posterolateral tibial plateau fracture(TPF).Methods A total of 114 patients with posterolateral TPF in Ruzhou First People's Hospital from January 2019 to March 2021 were selected for prospective randomized parallel controlled study.They were divided into groupA(n=57)and group B(n=57)according to the random number table method.Group B received surgical treatment via posterior medial incision(inverted L-shaped)approach,and group A received surgical treatment via posterolateral incision(vertical straight)approach of knee joint.The surgical effects,perioperative indicators,preoperative and 3 months postoperative tibial plateau(lateral)posterior inelination and knee joint flexion and extension range of motion,preoperative and postoperative 6 h traumatic stress factor[adrenocorticotropic hormone(ACTH),aldosterone(ALD),cortisol(Cor)]levels of two groups were compared.Results There was no signi ficant difference in the surgical effects between the two groups(P>0.05).The intraoperative blood loss in group A was less than that in group B,and the operation time was shorter than that in group B(P<0.05).The posterior inclination of tibial plateau in both groups improved 3 months after operation compared with preoperative(P<0.05),while there was no significant difference between the two groups(P>0.05).Serum ACTH,ALD,Cor levels at 6 h after operation in both groups were higher than those before operation,but group A was lower than group B(P<0.05).Conclusion The posterior medial incision(inverted L-shaped)approach and the posterol ateral incision(vertical straight)approach of the knee are effective in treating patients with post erolateral TPF.Both can effecti vely improve the posterior indlination of the tibial plateau,but the ltter has more advantages in optimizing perioperative indexes and alleviating surgical trauma stress.