后内侧倒“L”形切口三间隙显露入路手术对复杂胫骨平台骨折患者的影响

Effect of Posterior Medial Inverted“L”Incision Three Gap Exposure Approach Surgery on Patients with Complex Tibial Plateau Fractures

目的:探究后内侧倒“L”形切口三间隙显露入路手术对复杂胫骨平台骨折(complex tibial plateau fractures,CTPF)患者的影响。方法:选取厦门市第五医院2015年1月-2020年3月58例CTPF患者。按随机数字表法将其分成研究组(n=29)和对照组(n=29)。对照组接受后外侧入路手术治疗,研究组接受后内侧倒“L”形切口三间隙显露入路手术治疗。比较两组术后3个月手术效果,术前及术后1、3个月膝关节功能,术前、术后12 h炎症因子及凝血指标,术前、术后3个月骨代谢指标和并发症。结果:术后3个月,研究组优良率为96.55%,高于对照组的72.41%(P<0.05)。研究组术后1、3个月美国特种外科医院膝关节(HSS)评分均高于对照组(P<0.05)。术后12 h,研究组白细胞介素-1(IL-1)、白细胞介素-10(IL-10)、肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)水平均低于对照组(P<0.05)。术后12 h,研究组血栓素B2(TXB2)、内皮素-1(ET-1)水平均低于对照组,6-酮-前列腺素1α(6-keto-PGF1α)水平高于对照组(P<0.05)。术后3个月,研究组血清骨形态发生蛋白(BMP-2)、骨钙素(sOC)水平均高于对照组(P<0.05)。研究组并发症发生率为3.45%,低于对照组的27.59%(P<0.05)。结论:相较于后外侧入路手术治疗CTPF患者,应用后内侧倒“L”形切口三间隙显露入路手术治疗可以提升手术效果、改善膝关节功能、降低术后并发症,对机体凝血功能影响更小。

Objective:To investigate the effect of posterior medial inverted“L”incision three gap exposure approach surgery on patients with complex tibial plateau fractures(CTPF).Method:A total of 58 patients with CTPF in Xiamen Fifth Hospital from January 2015 to March 2020 were selected.They were divided into study group(n=29)and control group(n=29)according to the random number table method.The control group received posterolateral approach surgery treatment,and the study group received posterior medial inverted“L”incision three gap exposure approach surgery treatment.The surgery effects 3 months after surgery,knee joint function before and 1,3 months after surgery,inflammatory factors and coagulation indexes before and 12 hours after surgery,bone metabolism indexes before and 3 months after surgery and complications were compared between the two groups.Result:Three months after surgery,the excellent and good rate in the study group was 96.55%,which was higher than 72.41%in the control group(P<0.05).The Hospital for Special Surgery(HSS)scores in the study group were higher than those of the control group at 1 and 3 months after surgery(P<0.05).Twelve hours after surgery,interleukin-1(IL-1),interleukin-10(IL-10)and tumor necrosis factor-α(TNF-α),C-reactive protein(CRP)levels in the study group were lower than those in the control group(P<0.05).Twelve hours after surgery,the levels of thromboxane B2(TXB2)and endothelin-1(ET-1)in the study group were lower than those in the control group,and 6-keto-prostaglandin 1α(6-keto-PGF1α)level was higher than that in the control group(P<0.05).Three months after surgery,the levels of serum bone morphogenetic protein(BMP-2)and osteocalcin(sOC)in the study group were higher than those in the control group(P<0.05).The incidence of complications in the study group was 3.45%,which was lower than 27.59%in the control group(P<0.05).Conclusion:Compared with the posterolateral approach surgery in the treatment of CTPF patients,the use of the posterior medial inverted“L”incision three gap exposure approach surgery treatment can improve the surgical effect,improve the knee joint function,reduce postoperative complications,and have less impact on the body’s coagulation function.