前外侧入路解剖钢板内固定与后外侧Frosch入路支撑钢板内固定治疗胫骨平台后外侧骨折患者的疗效比较

Efficacy of anatomical plate internal fixation via anterolateral approach versus support plate internal fixation via posterolateral Frosch approach in the treatment of patients with posterolateral tibial plateau fractures:a comparative study

目的比较前外侧入路解剖钢板内固定与后外侧Frosch入路支撑钢板内固定治疗胫骨平台后外侧骨折患者的临床效果。方法回顾性分析39例胫骨平台后外侧骨折患者的临床资料,按手术方式分为前外侧解剖钢板组25例与后外侧支撑钢板组14例。前外侧解剖钢板组采用前外侧入路解剖钢板内固定治疗,后外侧支撑钢板组采用后外侧Frosch入路支撑钢板内固定治疗。比较两组患者的手术时间、术中出血量、切口长度、术后住院时间、住院费用、术后完全负重活动所需时间、术后6个月内并发症发生率、术后6个月的美国特种外科医院(HSS)膝关节评分与Rasmussen膝关节解剖评分,以及术后1 d及术后6个月的胫骨平台后倾角(PTS)、胫骨平台内翻角(TP-TSA)。结果两组患者的手术时间、术中出血量、切口长度、术后住院时间、住院费用、术后完全负重活动所需时间、术后6个月内并发症发生率、术后6个月HSS膝关节评分和Rasmussen膝关节解剖评分比较,差异均无统计学意义(均P>0.05)。后外侧支撑钢板组术后1 d的TP-TSA大于前外侧解剖钢板组(P<0.05);两组患者的术后1 d及术后6个月的PTS、术后6个月TP-TSA比较,以及各组内术后1 d与术后6个月的TP-TSA、PTS比较,差异均无统计学意义(均P>0.05)。结论采用前外侧入路解剖钢板内固定或后外侧Frosch入路支撑钢板内固定治疗胫骨平台后外侧骨折患者均能取得满意疗效,两者在手术时间、术中出血量、切口长度、术后并发症发生率等方面均无明显差异,临床上可根据患者实际情况及术者习惯进行选择。

Objective To compare the clinical effect between anatomical plate internal fixation via anterolateral approach and support plate internal fixation via posterolateral Frosch approach in the treatment of patients with posterolateral tibial plateau fractures.Methods The clinical data of 39 patients with posterolateral tibial plateau fractures were retrospectively analyzed,and they were assigned to anterolateral anatomical plate group(25 cases)or posterolateral support plate group(14 cases)according to the operation methods.The anterolateral anatomical plate group was treated with anatomical plate internal fixation via anterolateral approach,and the posterolateral support plate group was treated with support plate internal fixation via posterolateral Frosch approach.The operation duration,intraoperative bleeding volume,incision length,postoperative length of hospital stay,hospitalization expenses,postoperative full weight-bearing activity time,postoperative incidence rate of complications within 6 months,and 6-month postoperative Hospital for Special Surgery(HSS)knee joint score and Rasmussen knee joint anatomy score,as well as posterior tibial slope(PTS)and tibial plateau-tibial shaft angle(TP-TSA)1 day and 6 months after operation were compared between the two groups.Results There was no statistically significant difference in operation duration,intraoperative bleeding volume,incision length,postoperative length of hospital stay,hospitalization expenses,postoperative full weight-bearing activity time,postoperative incidence rate of complications within 6 months,and 6-month postoperative HSS knee joint score,Rasmussen knee joint anatomy score between the two groups(all P>0.05).One-day postoperative TP-TSA in the posterolateral support plate group was larger than that in the anterolateral anatomical plate group(P<0.05);furthermore,no statistically significant difference in 1-day and 6-month postoperative PTS and 6-month postoperative TP-TSA was found between the two groups,as well as there was no statistically significant difference in 1-day and 6-month postoperative TP-TSA and PTS between the various intragroups(all P>0.05).Conclusion Patients with posterolateral tibial plateau fractures employing anatomical plate internal fixation via anterolateral approach or support plate internal fixation via posterolateral Frosch approach all obtain a satisfactory efficacy.There is no significant difference in operation duration,intraoperative bleeding volume,incision length,postoperative incidence rate of complications,etc.between the two operation methods,and thus it can be chosen according to the actual situation of the patients and the surgeon′s habit in clinic.