早期临时跨关节外固定支架在SchatzkerⅥ型胫骨平台骨折中的应用

Application of Early Temporary Straddle Joint External Fixation Bracket in SchatzkerⅥType Fracture of the Tibial Plateau

目的:研究早期临时跨关节外固定支架在SchatzkerⅥ型胫骨平台骨折中的应用。方法:选择2018年2月-2021年2月南京医科大学附属逸夫医院收治的68例SchatzkerⅥ型胫骨平台骨折患者作为研究对象。根据随机数字表法将其分为试验组(n=34)和对照组(n=34)。两组均由急诊骨折快速通道进行影像学检查(X线、CT、MRI),接受Ⅰ期临时跨关节外固定支架+Ⅱ期钢板内固定手术治疗。试验组于急诊12 h内采用Ⅰ期临时跨关节外固定支架治疗,对照组于急诊24~72 h内采用Ⅰ期临时跨关节外固定支架治疗。比较两组随访末次膝关节功能,围手术期指标及并发症,软组织损伤指标。结果:两组优良率比较差异无统计学意义(P>0.05)。试验组Ⅰ期手术操作时间、Ⅰ期与Ⅱ期手术间隔时间、术后康复时间、骨折愈合时间均短于对照组(P<0.05)。试验组术后并发症发生率低于对照组(χ^(2)=5.581,P<0.05)。试验组Ⅰ期术后7 d水疱发生率为20.59%(7/34),低于对照组的64.71%(22/34)(χ^(2)=13.528,P<0.05)。试验组Ⅰ期术后7 d肿胀、疼痛、压痛、瘀斑评分均低于对照组(P<0.05)。结论:在SchatzkerⅥ型胫骨平台骨折早期应用临时跨关节外固定支架治疗能有效缩短患者内固定手术等待时间,促进患者骨折康复与愈合,改善患者外固定支架治疗后软组织损伤,值得推广研究。

Objective:To study the application of early temporary straddle joint external fixation bracket in SchatzkerⅥtype fracture of the tibial plateau.Method:A total of 68 patients with SchatzkerⅥtype fracture of the tibial plateau admitted to Sir Run Run Hospital Nanjing Medical University from February 2018 to February 2021 were selected as the study subjects.According to the random number table method,they were divided into test group(n=34)and control group(n=34).Both groups underwent imaging examination(X-ray,CT,MRI)through the emergency fracture fast track,and received stageⅠtemporary straddle joint external fixation bracket+stageⅡsteel plate internal fixation operation treatment.The test group was treated with stageⅠtemporary straddle joint external fixation bracket within 12 hours of the emergency,and the control group was treated with stageⅠtemporary straddle joint external fixation bracket within 24-72 hours of the emergency.The knee joint function at the last follow-up,perioperative indexes,complications and soft tissue injury indexes were compared between the two groups.Result:There was no significant difference in the excellent and good rate between the two groups(P>0.05).The operation time of stageⅠoperation,the interval between stageⅠand stageⅡoperation,the recovery time after operation and the fracture healing time in the test group were shorter than those in the control group(P<0.05).The incidence of postoperative complications in the test group was lower than that in the control group(χ^(2)=5.581,P<0.05).The incidence of blisters in the test group was 20.59%(7/34)at the 7 days after stageⅠoperation,which was lower than 64.71%(22/34)in the control group(χ^(2)=13.528,P<0.05).The scores of swelling,pain,tenderness and ecchymosis in the test group were lower than those in the control group at the 7 days after stageⅠoperation(P<0.05).Conclusion:The application of temporary straddle joint external fixation bracket treatment in the early stage of SchatzkerⅥtype fracture of the tibial plateau can effectively shorten the waiting time for internal fixation operation of patients,promote the recovery and healing of patients’fractures,and improve the soft tissue injury of patients after external fixation bracket treatment,which is worthy of promotion and study.