两种入路方式治疗胫骨平台后柱骨折的临床效果

Clinical effect of two approaches in treatment of posterior column of tibial plateau fracture

目的比较两种入路方式治疗胫骨平台后柱骨折的临床效果。方法抽取2016年1月至2021年1月新郑市人民医院收治的60例胫骨平台后柱骨折患者,按随机数字表法分为对照组(30例)和观察组(30例)。对照组采用后内侧Lobenhoffer入路,观察组采用腘窝后侧S形切口双窗口入路;比较两组手术及恢复相关指标;于术前、术后3个月,评估并比较两组膝关节功能包括Lysholm膝关节评分量表评分(Lysholm评分)及胫骨平台内翻角(TPA)、胫骨平台后倾角(PA),记录并比较两组术后3个月内并发症发生情况。结果观察组手术时间、骨折愈合时间短于对照组,术中出血量少于对照组(P<0.05);术后,两组Lysholm评分、TPA、PA高于术前,且观察组变化较大(P<0.05);两组术后并发症发生率比较,P>0.05。结论与后内侧Lobenhoffer入路比较,采用腘窝后侧S形切口双窗口入路进行手术,能够减少胫骨平台后柱骨折手术出血量,缩短骨折愈合时间,并促进膝关节功能恢复。

Objective To compare the clinical effect of two different approaches in the treatment of posterior column of tibial plateau fracture.Methods Sixty patients with posterior column fracture of tibial plateau in Xinzheng People’s Hospital from January 2016 to January 2021 were selected,they were divided into control group(30 cases)and observation group(30 cases)by a random number table method.The control group was treated by posteromedial Lobenhoffer approach,and the observation group was treated by double window approach through posterior S-shaped incision of popliteal fossa;the related indexes of operation and recovery were compared between the two groups;the knee function including Lysholm score,tibial plateau varus angle(TPA)and tibial plateau varus angle(PA)were evaluated and compared between the two groups before and 3 months after operation,the complications within 3 months after operation were recorded and compared between the two groups.Results The operation time and fracture healing time of the observation group were shorter than those of the control group,and the intraoperative blood loss was lower than that of the control group(P<0.05);after operation,the Lysholm score,TPA,PA of both groups were higher than those before operation,and the observation group had a greater change(P<0.05);the incidence of postoperative complications was compared between the two groups,P>0.05.Conclusions Compared with the posteromedial Lobenhoffer approach,the double window approach through posterior S-shaped incision of popliteal fossa in posterior column of tibial plateau fracture surgery can reduce the surgical blood loss,shorten the fracture healing time and promote the recovery of knee joint function.