伴冠状面膝关节脱位的SchatzkerⅣ型胫骨平台骨折患者主要韧带损伤特点临床研究

Clinical Study on Main Ligament Injury Characteristics of Schatzker TypeⅣTibial Plateau Fracture with Coronal Knee Dislocation

目的:探究伴冠状面膝关节脱位的SchatzkerⅣ型胫骨平台骨折患者的主要韧带损伤特点。方法:选取2019年1月至2022年12月在我院接受治疗的32例伴冠状面膝关节脱位的SchatzkerⅣ型胫骨平台骨折患者纳入研究组,另选58例单纯SchatzkerⅣ型胫骨平台骨折患者纳入对照组。分析比较两组患者的交叉韧带测量值、松紧度系数、膝关节软骨损伤程度、韧带功能指标、临床指标、膝关节HSS评分、VAS评分情况。结果:两组间La、Da、Dp比较差异无统计学意义(P>0.05),组间比较,研究组患者的Lp、TCa、TCp较对照组患者更高(P<0.05)。对两组患者的膝关节软骨损伤情况进行分析,可知两组间差异无统计学意义(P>0.05)。治疗前,两组患者的屈肌/伸肌峰力矩比值、肢体对称性测定值比较差异无统计学意义(P>0.05),经过治疗,患者的韧带功能有所改善,屈肌/伸肌峰力矩比值和肢体对称性测定值均升高,且研究组升高幅度大于对照组(P<0.05)。两组患者临床指标,包括手术时间、术中出血量、术后住院时间、骨折愈合时间及术后并发症发生率组间比较差异无统计学意义(P>0.05)。两组患者治疗前及术后6月的HSS评分比较差异无统计学意义(P>0.05),与对照组相比,研究组患者术后7d、术后1月、术后3月的HSS评分均更低(P<0.05)。两组患者治疗前及术后6月的VAS评分比较差异无统计学意义(P>0.05),与对照组相比,研究组患者术后7d、术后1月、术后3月的VAS评分均更高(P<0.05)。结论:与单纯SchatzkerⅣ型胫骨平台骨折患者相比,伴冠状面膝关节脱位的SchatzkerⅣ型胫骨平台骨折患者术后Lp、TCa、TCp升高,术后韧带恢复、膝关节功能及患者短期疼痛方面的表现较单纯SchatzkerⅣ型胫骨平台骨折患者更差,需予以格外关注。

Objective:To explore the main ligamentous injury characteristics in patients with Schatzker Type IV tibial plateau fracture accompanied by coronary knee dislocation.Methods:A total of 32 patients with Schatzker Type IV tibial plateau fracture accompanied by coronary knee dislocation,treated in our hospital from January 2019 to December 2022,were included in the study group.Additionally,58 patients with isolated Schatzker Type IV tibial plateau fracture were selected as the control group.The two groups were analyzed and compared for cross ligament measurements,laxity coefficients,degree of knee cartilage injury,ligament function indicators,clinical indicators,knee HSS scores,and VAS scores.Results:There was no statistically significant difference in La,Da,and Dp between the two groups(P>0.05).However,the study group showed higher values for Lp,TCa,and TCp compared to the control group(P<0.05).Analysis of knee carti-lage injury revealed no statistically significant difference between the two groups(P>0.05).Before treatment,there was no significant difference in the peak torque ratio of flexors/extensors and limb symmetry index be-tween the two groups(P>0.05).After treatment,both groups showed improved ligament function,with the study group exhibiting a greater increase in peak torque ratio and limb symmetry index compared to the control group(P<0.05).Clinical indicators,including operation time,intraoperative blood loss,postoperative hos-pitalization time,fracture healing time,and postoperative complication rate,showed no significant difference between the two groups(P>0.05).There was no statistically significant difference in HSS scores before and 6 months after treatment between the two groups(P>0.05).However,compared to the control group,the study group had lower HSS scores at 7 days,1 month,and 3 months postoperatively(P<0.05).Similarly,there was no significant difference in VAS scores before and 6 months after treatment between the two groups(P>0.05).Compared to the control group,the study group had higher VAS scores at 7 days,1 month,and 3 months postoperatively(P<0.05).Conclusion:Compared to patients with isolated Schatzker Type IV tibial plateau fractures,those with Schatzker Type IV tibial plateau fractures accompanied by coronary knee disloca-tion exhibited higher postoperative Lp,TCa,and TCp values,worse ligament recovery,poorer knee joint function,and greater short-term pain.These patients require additional attention.