mini-Swashbuckler入路与股骨前外侧入路联合LISS治疗C型股骨远端骨折患者的效果比较

Comparison of effects of min-Swashbuckler approach and anterolateral femoral approach combined with LISS in treatment of patients with type C distal femoral fractures

目的:比较mini-Swashbuckler入路与股骨前外侧入路联合微创内固定系统(LISS)治疗C型股骨远端骨折患者的效果。方法:选取2019年4月至2021年4月该院收治的60例C型股骨远端骨折患者进行前瞻性研究,按照随机数字表法分为对照组和观察组各30例。对照组采用股骨前外侧入路联合LISS治疗,观察组采用mini-Swashbuckler入路联合LISS治疗,比较两组骨折复位优良率,围术期指标水平,手术前后膝关节功能[美国特种外科医院(HSS)膝关节评分]评分及并发症发生率。结果:观察组手术时间长于对照组,术中出血量少于对照组,透视次数多于对照组,差异均有统计学意义(P<0.05);两组住院时间比较,差异无统计学意义(P>0.05);术后3个月,观察组HSS膝关节评分高于对照组,差异有统计学意义(P<0.05);两组骨折关节面复位有效率、并发症发生率比较,差异无统计学意义(P>0.05)。结论:mini-Swashbuckler入路联合LISS钢板治疗C型股骨远端骨折患者可减少术中出血量和提高HSS膝关节评分的效果优于股骨前外侧入路联合LISS钢板治疗,但需延长手术时间和增加透视次数。

Objective: To compare effects of min-Swashbuckler approach and anterolateral femoral approach combined with less invasive stabilization system(LISS) in treatment of patients with type C distal femoral fractures. Methods: A prospective study was conducted on 60 patients with type C distal femoral fractures admitted to the hospital from April 2019 to April 2021. They were divided into control group and observation group according to the random number table method, 30 cases in each. The control group was treated with anterolateral femoral approach combined with LISS, while the observation group was treated with mini-Swashbuckler approach combined with LISS. The perioperative index levels, the knee function [hospital for special surgery(HSS) knee score] scores before and after the surgery, the effective rate of postoperative fracture articular surface reduction, and the incidence of complications were compared between the two groups. Results: The operation time of observation group was longer than that of the control group;the intraoperative blood loss less than that of the control group;the perspective times were more than that of the control group;and the differences were statistically significant(P<0.05). There was no significant difference in the hospitalization time between the two groups(P>0.05). 3 months after the surgery, the HSS knee score of the observation group was higher than that of the control group, and the difference was statistically significant(P<0.05). There were no significant differences in the effective rate of fracture articular surface reduction and the incidence of complications between the two groups(P>0.05). Conclusions: Mini-Swashbuckler approach combined with LISS plate is superior to anterolateral approach combined with LISS plate in reducing the intraoperative blood loss and improving the HSS knee score in the treatment of type C distal femoral fractures, but the operation time is prolonged and the fluoroscopy times increase.