双切口双侧钢板与单侧锁定钢板内固定治疗Schatzker V型胫骨平台骨折的疗效

Curative effects of internal fixation with double incision bilateral plate and unilateral locking plate in the treatment of Schatzker V-type tibial plateau fracture

目的 探讨双切口双侧钢板与单侧锁定钢板内固定治疗Schatzker V型胫骨平台骨折的疗效。方法 选择我院收治的98例Schatzker V型胫骨平台骨折患者,根据内固定方式分为单侧锁定钢板组(47例)和双切口双侧钢板组(51例)。比较2组患者手术相关指标、术后恢复指标、膝关节胫骨平台内翻角(TPA)、胫骨平台后倾角(PA)、关节活动度(ROM)、膝关节功能、疼痛程度以及并发症发生情况。结果 双切口双侧钢板组术中出血量、术后引流量多于单侧锁定钢板组(P<0.05),骨折愈合时间长于单侧锁定钢板组(P<0.05),术后开始运动锻炼时间短于单侧锁定钢板组(P<0.05)。术后6个月、术后12个月2组TPA、PA、膝关节伸直ROM和屈曲ROM、美国纽约特种外科医院(HSS)评分、Rasmussen评分与术后即刻、术后1个月比较均升高(P<0.05),视觉模拟评分法(VAS)评分与术后即刻、术后1个月比较均降低(P<0.05),双切口双侧钢板组术后6个月、术后12个月膝关节伸直ROM和屈曲ROM、HSS评分、Rasmussen评分大/高于单侧锁定钢板组(P<0.05),TPA、PA、VAS评分小/低于单侧锁定钢板组(P<0.05)。双切口双侧钢板组患者膝关节僵硬发生率低于单侧锁定钢板组(P<0.05);2组患者切口感染发生率比较差异无统计学意义(P>0.05)。结论 与单侧锁定钢板内固定比较,双切口双侧钢板内固定减少胫骨平台骨折处移位和内翻,保持术后膝关节的稳定性的效果更佳,有利于术后早期运动锻炼和膝关节功能恢复。

Objective To investigate the curative effects of internal fixation with double incision bilateral plate and unilateral locking steel plate in the treatment of Schatzker V-type tibial plateau fracture.Methods A total of 98 patients with Schatzker V-type tibial plateau fracture treated in our hospital were selected.According to the internal fixation method, they were divided into the unilateral locking plate group(47 cases) and the double incision bilateral plate group(51 cases). The operation related indexes, postoperative recovery indexes, knee joint tibial plateau varus angle(TPA),tibial plateau posterior slope angle(PA),joint range of motion(ROM),knee joint function, degree of pain and incidence of complications between the two groups were compared.Results The amount of intraoperative bleeding and postoperative drainage in the double incision bilateral plate group were more than those in the unilateral locking plate group(P<0.05),the time of fracture healing was longer than that in the unilateral locking plate group(P<0.05),and the time to start exercise after operation was shorter than that in the unilateral locking plate group(P<0.05). At 6 months and 12 months after operation, TPA,PA,knee joint extension ROM and flexion ROM,hospital for special surgery(HSS) score and Rasmussen score in the two groups were higher than those immediately after operation and 1 month after operation(P<0.05),and visual analogue scale(VAS) scores were lower than those immediately after operation and 1 month after operation(P<0.05). At 6 months and 12 months after operation, knee joint extension ROM and flexion ROM,HSS score and Rasmussen score in the double incision bilateral plate group were higher than those in the unilateral locking plate group(P<0.05),and TPA,PA and VAS score were lower than those in the unilateral locking plate group(P<0.05). The incidence of knee joint stiffness in the double incision bilateral plate group was lower than that in the unilateral locking plate group(P<0.05). There was no statistically significant difference in the incidence of incision infection between the two groups(P>0.05).Conclusion Compared with unilateral locking plate internal fixation, double incision bilateral plate internal fixation can reduce the displacement and varus of tibial plateau fracture, and has better effect on maintaining the stability of postoperative knee joint, which is conducive to early postoperative exercise and the recovery of knee joint function.