不同手术入路治疗陈旧性胫骨平台骨折的效果对比

Comparison of Different Surgical Approaches in the Treatment of Old Tibial Plateau Fractures

目的对比前、后侧手术入路治疗陈旧后外侧胫骨平台骨折的效果。方法收集并整理2019年12月至2021年12月周口市中心医院收治的陈旧性胫骨平台后外侧骨折行翻修手术治疗的患者资料,共47例,根据手术入路分为两组:A组,经前外侧截骨入路(24例);B组,经后方入路(23例)。初次手术至翻修手术间隔6~12个月(平均9.6个月)。两组患者分别经前外、后方入路行手术复位钢板内固定。对比两组患者的手术时间、术中出血量、骨折愈合时间及负重时间、Rasmussen评分、美国特种外科医院(HSS)评分。结果所有患者术后均获得随访12~24个月,平均18.7个月。A组手术时间短于B组,术中出血量低于B组(P<0.05)。两组骨折愈合时间和完全负重时间对比,差异无统计学意义(P>0.05);两组患者末次随访时Rasmussen评分、HSS评分两组对比差异均无统计学意义(P>0.05)。结论与传统后侧入路相比,经前外侧关节内截骨治疗陈旧性胫骨平台后外侧骨折可缩短手术时间、减少术中出血量,术后随访患者骨折复位、功能恢复均良好,临床疗效可靠。

Objective To compare the efficacy of anterior and posterior surgical approach in the treatment of old posterolateral tibial plateau fractures.Methods The data of 47 patients with old posterolateral tibial plateau fractures treated in ZhouKou Central Hospital from December 2019 to December 2021 were collected and collated.According to different surgical approaches,47 patients were divided into two groups:group A accepted anterolateral osteotomy approach(24 cases)and group B accepted posterior approach(23 cases).The interval from initial operation to revision operation was 6-12 months(mean 9.6 months).The patients in the two groups were treated with open reduction and internal fixation with steel plate through anterior external approach and posterior approach,respectively.The operation time,intraoperative blood loss,fracture healing time and weight bearing time,as well as Rasmussen score and Hospital for Special Surgery(HSS)score at the last follow-up were compared between the two groups.Results All patients were followed up for 12-24 months(mean 18.7 months).The operation time in group A was shorter than group B,and intraoperative blood loss was lower than in group B(P<0.05).There was no statistical difference in fracture healing time and complete weight bearing time between the two groups(P>0.05).At the last follow-up,there was no statistical difference in the rates of Rasmussen score and knee joint function HSS score between the two groups(P>0.05).Conclusion Compared with the traditional posterior approach,anterolateral intra-articular osteotomy for the treatment of old posterolateral tibial plateau fractures can shorten the operation time,reduce the amount of intraoperative blood loss,and the clinical effect is reliable.