胫骨平台三柱骨折病人应用倒L入路联合外侧入路双钢板固定术治疗对其膝关节活动度的影响

Effect of inverted L approach combined with lateral approach with double plate fixation on knee range of motion in patients with three column fracture of tibial plateau

目的分析应用倒L入路联合外侧入路双钢板固定术对胫骨平台三柱骨折病人膝关节活动度的影响。方法2017年11月~2020年12月我院收治胫骨平台三柱骨折病人88例,根据治疗方法将其分为对照组和研究组。对照组44例采用外侧入路双钢板固定术,研究组44例实施倒L入路联合外侧入路双钢板固定术。比较两组手术疗效和术后恢复情况;比较两组术前、术后膝关节功能评分和生活质量评分。结果研究组手术时间为(90.12±11.30)分钟,术中出血量(463.20±70.10)ml,住院时间(3.08±1.12)天,膝关节锻炼时间(3.08±1.12)天,骨折完全愈合时间(14.58±2.64)周,可完全负重时间(16.27±3.65)周,均短于对照组[(98.42±12.18)分钟、(502.41±77.10)ml、(20.36±3.12)天、(5.54±1.69)天、(16.06±3.27)周、(18.67±4.21)周],差异有统计学意义(P<0.05)。研究组美国特种外科医院(HSS)各项评分(87.06±10.06)分、健康调查简表(SF-36)各项评分(82.69±10.30)分、愈合优良率(93.18%)、膝关节活动度[伸膝(9.54±2.36)、屈曲(135.28±28.48)]均高于对照组[(80.26±9.20)分、(74.12±9.20)分、(77.27%)、(8.06±2.06)、(121.64±22.61)],差异有统计学意义(P<0.05);两组术后并发症总发生率比较差异无统计学意义(P>0.05)。结论胫骨平台三柱骨折病人采用倒L入路联合外侧入路双钢板固定术进行治疗可提高膝关节活动度,促进骨折愈合,改善生活质量。

Objective To study the effect of double plate fixation through inverted L approach combined with lateral approach on the range of motion of knee joint in patients with three column fracture of tibial plateau.Methods Retrospectively,88 patients with tibial plateau triple column fractures admitted in the orthopedic department of Beijing Tongren Hospital affiliated to Capital Medical University from November 2017 to December 2,2020 were selected as the study subjects and divided into control group and study group according to the treatment methods.The control group,44 patients had lateral approach double plate fixation,and 44 patients had lateral approach double plate fixation combined with inverted L approach.Compare the surgical efficacy and postoperative recovery between the two groups;compare the preoperative and postoperative knee function scores and quality of life scores between the two groups.Results After operation,the operation time of the study group was(90.12±11.30)min,the intraoperative bleeding volume was(463.20±70.10)ml,and the hospital stay was(3.08±1.12)d,the time of knee joint exercise was(3.08±1.12)days,the time of complete fracture healing was(14.58±2.64)weeks and the time of complete weight-bearing was(16.27±3.65)weeks,which were shorter than those in the control group[(98.42±12.18)min,(502.41±77.10)ml,(20.36±3.12)d,(5.54±1.69)d,(16.06±3.27)weeks,(18.67±4.21)weeks](P<0.05).In study group,the scores of the American Special Surgery Hospital(HSS)were(87.06±10.06)points,the scores of the health survey summary(SF36)was(82.69±10.30)points,the rate of excellent and good healing(93.18%),and the range of motion of the knee joint[knee extension(9.54±2.36),flexion(135.28±28.48)],which were higher than those of the control group[(80.26±9.20),(74.12±9.20),(77.27%),(8.06±2.06)and(121.64±22.61)](P<0.05).There was no significant difference in the total incidence of postoperative complications between the two groups(P>0.05).Conclusion The treatment of patients with three column fracture of tibial plateau with lateral approach double plate fixation combined with inverted L approach can improve the range of motion of knee joint,promote fracture healing and improve the quality of life.