双反牵引辅助复位与切开复位内固定治疗胫骨平台骨折的疗效比较

Comparison of therapeutic effects between double traction-assisted reduction internal fixation and open reduction internal fixation for tibial plateau fractures

目的比较双反牵引辅助复位内固定与切开复位内固定治疗胫骨平台骨折的临床疗效.方法回顾性分析2016年1月至2021年12月四川大学华西医院收治的胫骨平台骨折患者资料,根据治疗方法分为双反牵引辅助复位内固定组(简称牵引组)和切开复位内固定组(简称切开组).牵引组21例,男15例、女6例,年龄(56.14±9.24)岁(范围45~72岁);骨折Schatzker分型:Ⅰ型1例、Ⅱ型2例、Ⅲ型2例、Ⅳ型5例、Ⅴ型6例、Ⅵ型5例.切开组29例,男20例、女9例,年龄(58.97±4.84)岁(范围47~70岁);骨折Schatzker分型:Ⅰ型2例、Ⅱ型4例、Ⅲ型8例、Ⅳ型4例、Ⅴ型5例、Ⅵ型6例.比较两组患者的手术时间、切口长度、术中出血量、住院时间、骨折愈合时间、术后完全负重时间、Rasmussen评分、纽约特种外科医院(Hospital for Special Surgery,HSS)膝关节评分及并发症等.结果两组患者均获得随访,随访时间24~36个月,平均30个月.牵引组与切开组的手术时间[(92.61±6.22)min和(47.92±9.53)min]、切口长度[(4.54±0.56)cm和(6.26±0.51)cm]及术中出血量[(47.05±9.72)ml和(156.82±4.62)ml]比较差异均有统计学意义(t=18.83、10.78、53.24,P<0.001).牵引组与切开组的住院时间[(5.35±0.41)d和(5.84±0.78)d]、骨折愈合时间[(3.72±0.74)个月和(4.22±0.42)个月]及术后完全负重时间[(11.29±1.10)周和(15.07±1.96)周]的差异均有统计学意义(t=2.30,P=0.026;t=3.38,P<0.001;t=7.96,P<0.001).牵引组术后6个月HSS评分为(81.61±2.32)分,大于切开组的(77.66±4.01)分,差异有统计学意义(t=4.07,P<0.001);术后12个月,牵引组Rasmussen评分为(16.71±1.00)分,大于切开组的(13.79±1.42)分,差异有统计学意义(t=8.05,P<0.001).两组均未发生骨折畸形愈合及骨筋膜室综合征.牵引组并发症发生率为5%(1/21),切开组并发症发生率为10%(3/29),两组并发症发生率的差异无统计学意义(χ^(2)=0.52,P=0.473).结论双反牵引辅助复位内固定治疗胫骨平台骨折具有创伤小、出血少、可早期活动、骨折愈合时间短的优势,是一种安全可靠的治疗方法.

Objective To explore the clinical efficacy of double traction-assisted reduction internal fixation and open reduction internal fixation in treating tibial plateau fractures.Methods Data of patients with tibial plateau fracture admitted to West China Hospital of Sichuan University from January 2016 to December 2021 were retrospectively analyzed,and patients were divided into two groups according to treatment method:double traction-closed reduction internal fixation group(referred to as double traction group)and open reduction internal fixation group(referred to as open group).The double traction group included 21 patients,with 15 male and 6 female patients,with a mean age of 56.14±9.24 years(range,45-72 years).Schatzker classification of fractures:1 type I,2 type II,2 type III,5 type IV,6 type V,and 5 type VI.The open group included 29 patients,with 20 male and 9 female patients,with a mean age of 58.97±4.84 years(range,47-70 years).Schatzker classification of fractures:2 type I,4 type II,8 type III,4 type IV,5 type V,and 6 type VI.The surgical time,incision length,intraoperative blood loss,length of hospital stays,fracture healing time,postoperative time to full weight bearing,Rasmussen score,Hospital for Special Surgery(HSS)knee score,and complications were compared between the two groups of patients.Results Both groups were followed up for 24 to 36 months,with an average of 30 months.There were significant differences in the operation time(92.61±6.22 min vs.47.92±9.53 min),incision length(4.54±0.56 cm vs.6.26±0.51 cm),and intraoperative blood loss(47.05±9.72 ml vs.156.82±4.62 ml)between the group treated with closed reduction and double traction and the group treated with open reduction,with statistical significance(t=18.83,10.78,53.24,P<0.001).There were also significant differences in the hospitalization time(5.35±0.41 d vs.5.84±0.78 d),fracture healing time(3.72±0.74 months vs.4.22±0.42 months),and time to full weight-bearing after surgery(11.29±1.10 weeks vs.15.07±1.96 weeks)between the two groups,with statistical significance(t=2.30,P=0.026;t=3.38,P<0.001;t=7.96,P<0.001).The HSS score at 6 months after surgery in the group treated with closed reduction and double traction was 81.61±2.32 points,which was higher than the score in the group treated with open reduction(77.66±4.01 points),with statistical significance(t=4.07,P<0.001);at 12 months after surgery,the Rasmussen score in the group treated with closed reduction and double traction was 16.71±1.00 points,which was higher than the score in the group treated with open reduction(13.79±1.42 points),with statistical significance(t=8.05,P<0.001).There was no fracture malunion or compartment syndrome occurred in both groups.The incidence of complications was 5%(1/21)in the group treated with closed reduction and double traction,and 10%(3/29)in the group treated with open reduction,with statistical significance(χ^(2)=0.52,P=0.473).Conclusion The advantages of double traction-assisted reduction and internal fixation for tibial plateau fractures include minimal trauma,minimal bleeding,early mobilization,and shorter fracture healing time.It is a safe and reliable treatment method.