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胫骨平台骨折是创伤骨科常见的膝关节内骨折,随着我国工业化的发展与公共交通的进步, 胫骨平台骨折发病率逐渐增加。作为常见的累及下肢负重关节的关节内骨折,胫骨平台骨折如治疗不当易导致膝关节疼痛、不稳及功能障碍[1]。其中,对于Schatzker Ⅱ型胫骨平台骨折的治疗,目前首选通过手术方式重建胫骨平台高度及宽度,恢复塌陷关节面,纠正下肢力线并稳定固定,以获得一个稳定、无痛、功能良好的膝关节。临床有多种针对塌陷胫骨平台关节面的复位方式,我院自2014年1月至2018年1月对25例Schatzker Ⅱ型胫骨平台骨折病人分别采用两种不同复位方式行手术治疗,比较分析其临床疗效。现作报道。
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2组病人术中出血量和手术时间差异均无统计学意义(P>0.05),B组切口长度明显小于A组(P < 0.01)(见表 1)。
分组 n 手术时间/min 出血量/mL 切口长度/cm A组 13 60.12±10.65 150.32±30.44 10.25±3.06 B组 12 65.38±12.32 135.42±21.66 5.35±2.35 t — 1.14 1.40 4.46 P — >0.05 >0.05 < 0.01 表 1 2组病人术中指标比较(x±s)
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B组膝关节开始锻炼时间和下地负重时间均明显少于A组(P < 0.01),2组骨折愈合时间差异无统计学意义(P>0.05)(见表 2)。2组病人术后即刻和术后3、6、12个月的TPA和PA差异均无统计学意义(P>0.05)(见表 3)。
分组 n 膝关节锻炼时间/d 愈合时间/周 负重时间/周 A组 13 14.33±1.25 17.31±3.52 14.24±2.67 B组 12 5.27±2.35 15.32±2.87 9.38±3.45 t — 11.89 1.54 3.96 P — < 0.01 >0.05 < 0.01 表 2 2组病人膝关节锻炼时间、愈合时间和负重时间比较(x±s)
分组 n 术后7 d内 术后3个月 术后6个月 F P MS组内 TPA/(°) A组 13 4.88±2.52 5.03±1.96 5.07±2.02 0.03 >0.05 4.758 B组 12 4.76±1.66 4.93±2.34 4.98±3.16 0.03 >0.05 6.072 t — 0.14 0.12 0.09 — — — P — >0.05 >0.05 >0.05 — — — PA/(°) A组 13 9.06±2.44 9.38±1.09 9.25±1.25 0.12 >0.05 2.901 B组 12 9.22±1.34 9.11±0.98 9.32±1.12 0.10 >0.05 1.337 t — 0.20 0.65 0.15 — — — P — >0.05 >0.05 >0.05 — — — 表 3 2组病人术后TPA和PA比较(x±s)
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A组术后膝关节恢复优良率为84.61%,与B组的90.67%比较,差异无统计学意义(P>0.05)(见表 4)。A组膝关关节HSS评分为(87.96±4.17)分,与B组的(89.01±3.58)分差异无统计学意义(t=0.67,P>0.05)。A组膝关节僵硬2例,切口感染1例,并发症发生率为23.08%(3/13);B组膝关节不稳1例,切口感染1例,并发症发生率为16.67%(2/12),2组差异无统计学意义(Fisher′s确切概率法,P>0.05)。
分组 n 优 良 可 差 优良率/% uc P A组 13 8 3 1 1 84.61 0.63 >0.05 B组 12 9 2 1 0 90.67 合计 25 17 5 2 1 88.00 表 4 2组病人膝关节恢复优良率比较(n)
两种胫骨平台关节面复位方式治疗Schatzker Ⅱ型胫骨平台骨折的疗效比较
Clinical comparison of two fracture reduction methods in the treatment of Schatzker type Ⅱ tibial plateay fractures
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摘要:
目的比较经胫骨平台外侧髁劈裂骨块直视下与胫骨近端开窗撬顶两种复位方式联合MIPPO接骨板治疗Schatzker Ⅱ型胫骨平台骨折的疗效。 方法选取Schatzker Ⅱ型胫骨平台骨折病人25例,随机分为A组13例和B组12例。其中,A组采用经胫骨平台外侧髁劈裂骨块翻开直视下复位胫骨平台塌陷,B组采用经胫骨近端开槽及顶棒撬顶复位,2组均联合MIPPO技术解剖钢板内固定。比较2组病人的相关手术指标。 结果2组病人术中出血量和手术时间差异均无统计学意义(P>0.05),B组切口长度明显小于A组(P < 0.01)。B组病人膝关节开始锻炼时间和下地负重时间均明显少于A组(P < 0.01),2组骨折愈合时间差异无统计学意义(P>0.05)。2组病人术后即刻和术后3、6、12个月的胫骨平台内翻角和后倾角度数差异均无统计学意义(P>0.05)。A组术后膝关节恢复优良率为84.61%,与B组的90.67%比较差异无统计学意义(P>0.05)。2组膝关节HSS评分差异和并发症发生率差异均无统计学意义(P>0.05)。 结论2种胫骨平台关节面复位方法均可有效恢复Schatzker Ⅱ型胫骨平台骨折关节面,其中胫骨近端开窗撬顶复位更加微创,有助于病人术后及早恢复。 Abstract:ObjectiveTo compare the efficacy between direct vision of the split bone block of the lateral condyle of the tibial plateau and tibial proximal feneway crowbar combined with MIPPO bone plate in the treatment of Schatzker type Ⅱ tibial plateau fractures. MethodsTwenty-five patients with Schatzker type Ⅱ tibial plateau fractures were divided into the group A(13 cases) and group B(12 cases).The tibial plateau collapse in group A was reduced by direct vision of the split bone block of the lateral condyle of the tibial plateau, the group B was reduced by slotting tibial plateau and prying top bar, and two groups were additionally treated with MIPPO technique for anatomical plate internal fixation. ResultsThere was no statistical significance in operative time and bleeding loss between two groups(P>0.05), and the length of incision in B group was significantly shorter than that in A group(P < 0.01).The starting time of knee joint exercise and bearing weight time in B group were significantly less than those in A group(P < 0.01), and there was no statistical significance in healing time of fracture between two groups(P>0.05).The differences of the varus angle and caster angle of tibial plateau between to groups at the end of operation, and postoperative 3, 6 and 12 months were not statistically significant(P>0.05).The excellent and good recovery rate of knee joint after operation in group A and group B were 84.61% and 90.67%, respectively, and the difference of which between two groups was not statistically significant(P>0.05).The difference of the HSS score of knee joint and incidence rate of complications between two groups was not statistically significant(P>0.05). ConclusionsBoth kinds of articular surface of tibial plateau reset method can effectively restore the tibial plateau joint surface.The reduction of open window in proximal tibia is more minimally invasive, which can improve the recovery of patients. -
Key words:
- tibial fracture /
- reduction /
- mini-invasive surgical treatment
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表 1 2组病人术中指标比较(x±s)
分组 n 手术时间/min 出血量/mL 切口长度/cm A组 13 60.12±10.65 150.32±30.44 10.25±3.06 B组 12 65.38±12.32 135.42±21.66 5.35±2.35 t — 1.14 1.40 4.46 P — >0.05 >0.05 < 0.01 表 2 2组病人膝关节锻炼时间、愈合时间和负重时间比较(x±s)
分组 n 膝关节锻炼时间/d 愈合时间/周 负重时间/周 A组 13 14.33±1.25 17.31±3.52 14.24±2.67 B组 12 5.27±2.35 15.32±2.87 9.38±3.45 t — 11.89 1.54 3.96 P — < 0.01 >0.05 < 0.01 表 3 2组病人术后TPA和PA比较(x±s)
分组 n 术后7 d内 术后3个月 术后6个月 F P MS组内 TPA/(°) A组 13 4.88±2.52 5.03±1.96 5.07±2.02 0.03 >0.05 4.758 B组 12 4.76±1.66 4.93±2.34 4.98±3.16 0.03 >0.05 6.072 t — 0.14 0.12 0.09 — — — P — >0.05 >0.05 >0.05 — — — PA/(°) A组 13 9.06±2.44 9.38±1.09 9.25±1.25 0.12 >0.05 2.901 B组 12 9.22±1.34 9.11±0.98 9.32±1.12 0.10 >0.05 1.337 t — 0.20 0.65 0.15 — — — P — >0.05 >0.05 >0.05 — — — 表 4 2组病人膝关节恢复优良率比较(n)
分组 n 优 良 可 差 优良率/% uc P A组 13 8 3 1 1 84.61 0.63 >0.05 B组 12 9 2 1 0 90.67 合计 25 17 5 2 1 88.00 -
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