倒L入路联合前外侧入路三钢板固定术治疗胫骨平台三柱骨折的效果观察

Effects of three-plate fixation through inverted L-shaped approach combined with anterolateral approach on patients with three-column fractures of tibial plateau

目的探讨倒L入路联合前外侧入路三钢板固定术治疗胫骨平台三柱骨折的临床效果及其对膝关节活动度的影响。方法抽取2019年9月至2021年9月在湘乡市人民医院接受治疗的胫骨平台三柱骨折患者120例,对其病历资料进行回顾性分析。依据手术方式将纳入患者分为A组(62例)和B组(58例)。A组患者行后内侧联合前外侧入路双钢板固定术,B组患者行倒L入路联合前外侧入路三钢板固定术。比较两组手术相关指标、视觉模拟评分法(VAS)评分、膝关节活动度[内翻角(TPA)、后倾角(PSA)及屈曲度]、膝关节功能[美国纽约特种外科医院(HSS)]评分及术后并发症发生情况。结果B组手术时间[(99.67±12.46)min]长于A组[(91.56±11.45)min],P<0.05;B组术后下床时间[(21.28±2.66)min]、住院时间[(15.18±1.90)d]均短于A组[(25.36±3.17)min、(17.26±2.66)d],P均<0.05;两组术中出血量和术后骨折愈合时间比较差异未见统计学意义(P>0.05)。术前及术后1周、1个月,两组VAS评分比较差异未见统计学意义(P>0.05),但两组术后1周、1个月时的VAS评分均低于同组术前(P均<0.05)。术后1 h及2个月,两组TPA、PSA比较差异未见统计学意义(P>0.05),但两组术后2个月的膝关节活动度均较术后1 h时改善,且B组优于A组(P<0.05)。术后1、2个月,两组HSS评分均较术前升高,且B组高于A组(P<0.05)。A组术后并发症发生率(9.69%,6/62)与B组(8.62%,5/58)比较差异未见统计学意义(P>0.05)。结论胫骨平台三柱骨折患者应用倒L入路联合前外侧入路三钢板固定术手术时间较长,但能促进患者术后康复,有利于改善膝关节活动度,促进膝关节功能的恢复。

Objective To investigate the clinical effects of three-plate fixation through inverted L-shaped approach combined with anterolateral approach on three-column fractures of tibial plateau.Methods A total of 120 patients with three-column fractures of tibial plateau who were treated in Xiangxiang People’s Hospital from September 2019 to September 2021 were selected for the retrospective analysis.According to surgical methods,they were divided into group A(62 cases)and group B(58 cases).The group A underwent double plate fixation through postero-medial approach combined with anterolateral approache,and the group B underwent three-plate fixation through inverted L-shaped approach combined with anterolateral approach.The operation related indexes,visual analogue scale(VAS)score,knee joint range of motion assessed by tibial plateau angle(TPA),posterior slope angle(PSA)and range of motion,knee joint function assessed by hospital of special surgery(HHS)and postoperative complications were compared between the two groups.Results The operation time in the group B was(99.67±12.46)min,longer than(91.56±11.45)min in the group A(P<0.05);but postoperative leaving bed time and hospitalization time in the group B were(21.28±2.66)min and(15.18±1.90)d,respectively,shorter than(25.36±3.17)min and(17.26±2.66)d in the group A(all P<0.05).There was no significant difference between the two groups in the amount of bleeding during operation and the time of fracture healing after operation(P>0.05).Before surgery,1 week and 1 month after surgery,there was no significant difference in VAS score between the two groups(P>0.05),but the VAS scores of the two groups 1 week and 1 month after operation were lower than those of the same group before operation(all P<0.05).At 1 hour and 2 months after surgery,there was no significant difference in TPA and PSA between the two groups(P>0.05),however,the range of motion in the two groups 2 months after surgery was improved,compared with that at 1 hour after surgery,and the range of motion in the group B was better than that in the group A(P<0.05).One month and 2 months after operation,the HSS scores in both groups were higher than those before operation,and HSS scores in the group B were higher than those in the group A(P<0.05).There was no significant difference in the incidence of postoperative complications between the group A(9.69%,6/62)and the group B(8.62%,5/58),P>0.05.Conclusions The operation time of three-plate fixation through inverted L-shaped approach combined with anterolateral approach is long in patients with three-column fractures of tibial plateau.However,it can promote postoperative rehabilitation,which is beneficial to improve range of motion and promote the recovery of knee function.