双反牵引复位辅助有限切开内固定治疗胫骨平台双髁骨折

Minimally invasive technique for tibial plateau bicondylar fracture repair using the double reverse traction repositor

目的探讨双反牵引复位辅助有限切开内固定治疗胫骨平台双髁骨折的疗效.方法回顾性分析2017年1月至2022年1月山东第一医科大学附属山东省立医院创伤中心收治31例胫骨平台双髁骨折患者的病历资料,男21例、女10例,年龄(32.4±6.5)岁(范围18~67岁).按Schatzker分型:Ⅴ型17例、Ⅵ型14例.受伤至手术时间为(6.1±1.3)d(范围5~11 d).所有患者均采用双反牵引复位辅助有限切开内外侧双钢板固定,必要时附加螺钉固定.记录患者受伤至手术时间、手术时间、术中出血量、住院时间、骨折愈合时间及并发症发生情况,术后及术后12个月观察并测量胫骨平台关节面压缩程度、内倾角、后倾角和膝关节活动度,采用膝关节功能Rasmussen评分、疼痛视觉模拟评分(visual analogue scale,VAS)评估膝关节功能.结果31例患者均顺利完成手术,手术时间为(109.2±15.6)min(范围70~160 min),术中出血量为(176.5±20.8)ml(范围90~380ml),住院时间为(12.2±0.8)d(范围10~15 d),随访时间为(13.5±1.1)个月(范围12~20个月).所有患者均获得骨性愈合,骨折愈合时间为(14.6±1.5)周(范围11~20周).术后及术后12个月关节面压缩分别为(0.45±0.13)mm和(0.58±0.21)mm,胫骨平台内倾角分别为87.65°±3.21°和87.02°±3.68°,胫骨平台后倾角分别为6.92°±1.98°和6.50°±2.01°,差异均无统计学意义(P>0.05).术后12个月膝关节活动度为125.6°±2.1°(范围0°~135°),膝关节功能Rasmussen评分为(25.4±1.7)分(范围18~28分),VAS评分为(0.7±0.2)分(范围0~2分).所有患者均无切口脂肪液化、感染、皮肤坏死、钢板外露等并发症发生,无骨折延迟愈合、内固定失效.术后1年6例患者发生创伤性关节炎.结论应用双反牵引复位辅助有限切开内固定治疗胫骨平台双髁骨折可以获得满意的疗效.

Objective To assess the efficacy of a minimally invasive technique for repairing tibial plateau bicondylar fractures utilizing the double reverse traction repositor.Methods A retrospective analysis was performed of the data of 31 patients(Schatzker V 17 cases,Schatzker VI 14 cases)who had been admitted to trauma center of Shandong provincial hospital affiliated to Shandong first medical university for tibial plateau bicondylar fractures from January 2017 to January 2022.There were 21 males and 10 females,aged from 18 to 67 years(average,32.4±6.5 years).The intervention strategy comprised the use of a double reverse traction repositor and was augmented by precise screw fixation.A comprehensive set of parameters were measured,including time interval between injury and operation,operation time,blood loss,hospital stay,fracture healing time,incision complications.Postoperative assessments were made immediately and at the 12-month mark,including the evaluation of articular step-off height,medial tibial plateau angle,and posterior tibial slope angle.The evaluation also included thTime interval between injury and operation ranged from 5 to 11 days,with an average of 6.1±1.3 days.The surgical procedures varied in length from 70 to 160 minutes,averaging at 109.2±15.6 minutes.The volume of blood loss was noted to be between 90 to 380 ml,averaging at 176.5±20.8 ml.Hospitalization spanned from 10 to 15 days,with an average stay of 12.2±0.8 days.Over a follow-up duration of 12 to 20 months,averaging at 13.5±1.1 months,all patients achieved fracture union within a period of 11 to 20 weeks,with an average time of 14.6±1.5 weeks.The postoperative articular step-off was recorded at 0.45±0.13 mm immediately after surgery and 0.58±0.21 mm at the one-year follow-up.Similarly,the medial tibial plateau angle and posterior tibial slope angle showed marginal changes from the immediate postoperative period to the 12-month evaluation.Knee joint mobility at the one-year mark ranged impressively from 0°to 135°,with an average of 125.6°±2.1°.Functional outcomes as reflected by Rasmussen scores ranged from 18 to 28 points,with an average of 25.4±1.7 points.Pain,as assessed by the VAS,had a low score range of 0 to 2 points,averaging at 0.7±0.2 points.Notably,there were no postoperative complications associated with the incisions,such as fat liquefaction,infection,skin necrosis,or exposure of internal fixations.Additionally,no cases of delayed union or fixation failure were observed.Six patients had traumatic arthritis 1 year after operation.Conclusion The minimally invasive double reverse traction repositor technique for tibial plateau bicondylar fracture repair is effective,warranting its broader application in orthopedic surgery.