两种不同联合入路在累及后外侧Schatzker Ⅳ型胫骨平台骨折中的应用效果对比

Comparison of two different combined approaches in treatment of posterolateral Schatzker type IV tibial plateau fracture

目的 对比内侧联合后外侧入路与后内侧倒“L”切口联合前外侧入路在累及后外侧SchatzkerⅣ型胫骨平台骨折中的应用效果。方法 选取2019年2月至2022年3月在江苏省淮安市第一人民医院分院就诊的胫骨平台骨折的患者89例,根据治疗方式不同分为后外侧入路组(n=45)和前外侧入路组(n=44)。后外侧入路组行内侧联合后外侧入路固定,前外侧入路组行后内侧倒“L”切口联合前外侧入路固定。对两组手术相关指标、并发症、术后骨折复位、膝关节功能恢复情况进行比较。结果 两组术后引流量和愈合时间比较,差异无统计学意义(P>0.05);与前外侧入路组相比,后外侧入路组手术时间及住院时间缩短,失血量减少(P<0.05)。术后3 d,两组Rasmussen总分及关节面塌陷、髁部变宽、成角畸形单项评分比较,差异均有统计学意义(P<0.05),但后外侧入路组与前外侧入路组比较,差异无统计学意义(P>0.05);两组术后3 d Rasmussen评分的优良率比较,差异无统计学意义(95.56%vs 100%,P>0.05)。术后12个月,两组疼痛、功能评分、活动度、肌力、屈膝畸形、稳定性评分较术前升高,减分项目评分较术前降低(P<0.05),但后外侧入路组与前外侧入路组总分及单项评分比较,差异无统计学意义(P>0.05);后外侧入路组与前外侧入路组的HSS评分优良率比较,差异无统计学意义(77.78%vs 81.82%,P>0.05)。术后12个月,两组膝关节活动范围比较,差异无统计学意义(P>0.05)。两组并发症发生情况比较,差异无统计学意义(13.33%vs 9.09%,P>0.05)。结论 内侧联合后外侧入路与后内侧倒“L”切口联合前外侧入路对累及后外侧SchatzkerⅣ型胫骨平台骨折均有较好的治疗效果,可明显改善膝关节功能,前者的手术时间短,术中失血量少,术后恢复更快,对骨折累及干骺端选择后者入路更佳,临床上可根据骨折情况选择合适的手术入路。

Objective To compare the application effect of the medial combined posterior lateral approach and the posterior medial inverted"L"incision combined with the anterior lateral approach in the treatment of Schatzker type IV tibial plateau fractures involving the posterior lateral aspect.Methods89 patients with tibial plateau fractures who were treated at the First People′s Hospital Branch of Huai′an City,Jiangsu Province from February 2019 to March 2022 were selected.They were divided into a posterior lateral approach group(n=45)and a anterior lateral approach group(n=44)according to different treatment methods.The posterior lateral approach group underwent medial combined with posterior lateral approach fixation,while the anterior lateral approach group underwent posterior medial inverted"L"incision combined with anterior lateral approach fixation.Compare the surgical related indicators,complications,postoperative fracture reduction,and knee joint function recovery between two groups.ResultsThe difference in postoperative drainage volume and healing time between the two groups was not statistically significant(P>0.05);Compared with the anterior lateral approach group,the posterior lateral approach group had shorter surgical and hospitalization times,and reduced blood loss(P<0.05).After 3 days of surgery,there was a statistically significant difference in the total Rasmussen score,joint surface collapse,condylar widening,and angular deformity scores between the two groups(P<0.05),but there was no statistically significant difference between the posterior lateral approach group and the anterior lateral approach group(P>0.05);There was no statistically significant difference(95.56%vs 100%,P>0.05)in the excellent rate of postoperative Rasmussen scores between the two groups.After 12 months of surgery,the pain,functional score,range of motion,muscle strength,knee flexion deformity,and stability scores of the two groups increased compared to before surgery,while the score of the reduced items decreased compared to before surgery(P<0.05).However,there was no statistically significant difference in total score and individual score between the posterior lateral approach group and the anterior lateral approach group(P>0.05);There was no statistically significant difference in the excellent rate of HSS scores between the posterior lateral approach group and the anterior lateral approach group(77.78%vs 81.82%,P>0.05).After 12 months of surgery,there was no statistically significant difference in the range of motion of the knee joints between the two groups(P>0.05).There was no statistically significant difference in the incidence of complications between the two groups(13.33%vs 9.09%,P>0.05).ConclusionBoth the medial combined posterior lateral approach and the posterior medial inverted"L"incision combined with the anterior lateral approach have good therapeutic effects on Schatzker type IV tibial plateau fractures involving the posterior lateral side,and can significantly improve knee joint function.The former has a shorter surgical time,less intraoperative blood loss,and faster postoperative recovery.The latter approach is better for fractures involving the metaphysis.In clinical practice,a suitable surgical approach can be selected based on the fracture situation.