顺势双向牵引治疗胫骨平台骨折的临床研究

Clinical study on the treatment of tibial plateau fractures with bidirectional traction reduction and internal fixation

目的观察顺势双向牵引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2019年6月至2023年6月本院收治的38例单侧胫骨平台骨折患者的病例资料。其中19例采用顺势双向牵引复位器复位后锁定钢板固定(牵引组)、19例采用常规方式复位钢板内固定(切开组)。两组患者均得到满意随访。分别记录并比较两组患者切口长度、术中X线透视次数、术中骨折复位时间、手术出血量、手术总用时、术后2周(visualanalogue scale,VAS)疼痛评分、术后6月患者患肢(Hospital for Special Surgery,HSS)膝关节评分,记录患者术后并发症。结果所有患者骨折均顺利愈合。牵引组患者的术中骨折复位及手术总时长、术中X线透视次数、手术出血量、手术切口长度、术后2周疼痛VAS评分相对于传统切开组均存在优势,组间差异存在统计学意义(P<0.05)。牵引组术后并发症发生率少于传统切开组,差异存在统计学意义(P<0.05)。术后6个月HSS膝关节评分比较,两组患者组间差异无统计学意义(P>0.05)。结论应用顺势双向牵引复位内固定治疗胫骨平台骨折对比传统方法,术后并发症发生率低,且手术切口减小、术中出血量减少、术后疼痛减轻、术中应用X线透视次数少、术中骨折复位时间及总手术时间短。

Objective To observe the clinical efficacy of bidirectional traction reduction and internal fixation in the treatment of tibial plateau fractures.Methods A retrospective analysis was conducted on the clinical data of 38 patients with unilateral tibial plateau fractures admitted to our hospital from June 2019 to June 2023.19 patients were treated with a bidirectional traction reduction device followed by locking steel plate fixation(traction group),and 19 patients were treated with conventional reduction steel plate internal fixation(incision group).All patients were received satisfactory follow-up.The incision length,intraoperative X-ray fluoroscopy frequency,intraoperative fracture reduction time,surgical bleeding volume,total surgical time,visual analogue scale(VAS)pain score at 2 weeks after surgery,Hospital for Special Surgery(HSS)knee joint score at 6 months after surgery and the postoperative complications were recorded and compared.Results The fractures healed smoothly in all patients.The traction group had advantages in intraoperative fracture reduction and total surgical duration,intraoperative X-ray fluoroscopy frequency,surgical bleeding volume,surgical incision length,and VAS score of postoperative pain at 2 weeks compared to the traditional incision group,with statistically significant differences(P<0.05).The incidence of postoperative complications in the traction group was lower than that in the traditional incision group,and the difference was statistically significant(P<0.05).6 months after surgery,there was no statistically significant difference in HSS knee joint scores between the two groups of patients(P>0.05).Conclusion Compared with traditional methods,the application of bidirectional traction reduction and internal fixation in the treatment of tibial plateau fractures has a lower incidence of postoperative complications,reduced surgical incision,reduced intraoperative bleeding,reduced postoperative pain,fewer intraoperative X-ray fluoroscopy applications,and shorter intraoperative fracture reduction and total surgical time.