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有学者[1]基于CT检查结果提出的胫骨平台三柱理论是对Schatzker分型[2]进一步有益补充, 从而对胫骨平台骨折的情况了解更加全面, 有利于指导手术治疗。罗从风等[1]提出的前外侧切口联合后内侧倒型切口入路三柱固定治疗胫骨平台三柱骨折, 临床得到了推广, 并取得了良好疗效。本研究中2010年1月至2017年2月, 扬州市广陵区中医院骨科和江苏省苏北人民医院骨科采用前外侧单一切口入路复位、植骨、三钢板内固定技术治疗胫骨平台三柱骨折, 取得较好效果。现作报道。
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观察组手术时间、术中出血量、术后引流量均明显少于对照组(P < 0.01), 但2组骨折愈合时间比较差异无统计学意义(P>0.05)(见表 1)。
分组 n 手术时间/min 术中出血量/mL 术后引流量/mL 骨折愈合时间/月 观察组 23 85.3±13.4 300.7±41.2 51.4±9.2 4.5±0.7 对照组 23 110.5±10.6 490.3±30.7 80.7±13.1 4.6±0.5 t - 7.07 17.70 8.78 0.56 P - < 0.01 < 0.01 < 0.01 >0.05 表 1 2组手术相关指标比较($\bar{x}\pm s$)
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术前、术后2组内翻角、后倾角测量值差异均无统计学意义(P>0.05), 术后2组内翻角、后倾角测量值均明显小于术前(P < 0.01)(见表 2)。
分组 n 内翻角/(°) 后倾角/(°) 术前 观察组 23 103.2±3.2 17.5±2.4 对照组 23 102.6±2.1 16.9±2.2 t - 0.75 0.90 P - >0.05 >0.05 术后 观察组 23 84.7±3.3** 10.6±1.2** 对照组 23 85.3±4.1** 10.5±1.1** t - 0.55 0.29 P - >0.05 >0.05 组内配对t检验:**P < 0.01 表 2 2组术前、后胫骨平台内翻角及后倾角测量值比较($\bar{x}\pm s$)
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2组术后6个月及18个月Rasmussen放射学评分及HSS膝关节功能评分比较, 差异均无统计学意义(P>0.05), 2组治疗前后比较差异亦均无统计学意义(P>0.05)(见表 3)。
分组 n HSS评分/分 Rasmussen评分/分 术后6个月 观察组 23 87.9±12.0 16.2±1.7 对照组 23 85.4±12.8 15.7±2.1 t - 0.68 0.89 P - >0.05 >0.05 术后18个月 观察组 23 85.9±12.9 15.8±2.1 对照组 23 85.5±12.3 14.5±2.3 t - 0.11 2.00 P - >0.05 >0.05 表 3 2组术后6个月及18个月Rasmussen放射学及HSS膝关节功能评分比较
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观察组1病例患侧小腿1周内肿胀明显, 排除深静脉血栓形成, 1周后基本消退, 均未发生切口感染、切口延迟愈合、内固定松动断裂、骨折不愈、明显创伤性关节炎等情况。对照组1例术后小腿肿胀明显, 排除深静脉血栓形成, 1周后基本消退; 2例发生切口表浅感染, 予多次无菌换药及抗生素点滴切口延迟愈合, 未发生内固定松动断裂、骨折不愈、明显创伤性关节炎等情况。2组切口感染率差异无统计学意义(χ2=0.27, P>0.05)。
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典型病例为男, 42岁, 右膝车祸致伤, 治疗前后对照见图 1。
前外侧单切口三钢板固定治疗胫骨平台三柱骨折的临床观察
Clinical observation of three-plate fixation with anterolateral single incision in the treatment of three-column fractures of tibial plateau
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摘要:
目的 探讨前外侧单切口三钢板固定治疗胫骨平台三柱骨折的临床效果和应用价值。 方法 选择2010年1月至2017年2月收治胫骨平台三柱骨折病人46例。按随机数字法分为观察组和对照组,每组23例。观察组采用前外侧单切口三钢板固定治疗方案;对照组采用前外侧切口联合后内侧倒L型双切口三钢板固定治疗方案。术后2组治疗要求等同,定期进行临床及影像学检查,并采用Rasmussen放射学评分及美国特种外科医院(HSS)评分进行膝关节功能评估。 结果 46例均获得随访,随访时限18~24个月。观察组手术时间、术中出血量、术后引流量均明显少于对照组(P < 0.01),但2组骨折愈合时间比较差异无统计学意义(P>0.05);术前、术后2组内翻角、后倾角测量值差异均无统计学意义(P>0.05),术后2组内翻角、后倾角测量值均明显小于术前(P < 0.01)。2组术后6个月及18个月Rasmussen放射学评分及HSS膝关节功能评分比较差异均无统计学意义(P>0.05),2组治疗前后比较差异亦均无统计学意义(P>0.05)。2组术后感染率差异均无统计学意义(P>0.05)。 结论 前外侧单切口三钢板固定治疗相对于前外侧切口联合后内侧倒L型双切口三钢板固定治疗胫骨平台三柱骨折,在恢复关节面的平整及力学稳定性、膝关节功能方面无明显差异性。前外侧单切口三钢板固定方案比前外侧切口联合后内侧倒L型双切口入路复位三钢板固定治疗方案具有一定优势:术中操作简便,创伤小,手术时间短,出血少;前外侧单切口术后换药方便,不增加感染风险,值得临床推广。 Abstract:ObjectiveTo investigate the clinical effects and application value of three plate-fixation with anterolateral single incision in the treatment of three-column fractures of tibial plateau. MethodsForty-six patients with three-column fractures of tibial plateau from January 2010 to February 2017 were divided into the observation group and control group according to the random number method(23 cases in each group).The observation group was treated with three-plate fixation with anterolateral single incision, and the control group was treated with anterolateral incision combined with retromedial inverted L-shape double incision and three-plate fixation.The postoperative treatment in two groups were the same, the clinical and imaging examinations were conducted regularly, and the knee joint function was evaluated using Rasmussen radiological score and American hospital for special surgery(HSS) score. ResultsAll cases were followed up for 18-24 months.The operation time, intraoperative blood loss and postoperative drainage volume in observation group were significantly less than those in control group(P < 0.01), and there was no statistical difference in the healing time of fracture between two groups(P>0.05).There was no statistical significance in values of varus angle and rake angle between two groups before and after surgery(P>0.05), while the values of varus angle and rake angle in two groups after operation were significantly less than those before operation(P < 0.01).There was no statistical significance in Rasmussen radiology score and HSS knee function score between two groups after 6 and 18 months of operation, and the difference of which in two groups between before and after treatment was not statistically significant(P>0.05).The different of the infection rate in two group was not statistically significant(P>0.05). ConclusionsCompared with the anterolateral incision combined with retromedial inverted L-shape three-plate fixation, the three-plate fixation with anterolateral single incision in treating the tibial plateau three-column fractures can restore the joint surface smooth and mechanical stability, and there is no significant difference in the function of knee joint between two groups.The three-plate fixation with anterolateral single incision in treating the tibial plateau three-column fractures is better than that of the anterolateral incision combined with retromedial inverted L-shape three-plate fixation, which has the advantages of simple operation, less trauma, shorter operation time, less bleeding and ease to change medicine, and can obviously reduce the risk of infection, so it is worthful of popularization in clinic. -
Key words:
- tibial plateau fracture /
- three-column injury /
- anterolateral single incision /
- tri-plate /
- bone graft
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表 1 2组手术相关指标比较(
)$\bar{x}\pm s$ 分组 n 手术时间/min 术中出血量/mL 术后引流量/mL 骨折愈合时间/月 观察组 23 85.3±13.4 300.7±41.2 51.4±9.2 4.5±0.7 对照组 23 110.5±10.6 490.3±30.7 80.7±13.1 4.6±0.5 t - 7.07 17.70 8.78 0.56 P - < 0.01 < 0.01 < 0.01 >0.05 表 2 2组术前、后胫骨平台内翻角及后倾角测量值比较(
)$\bar{x}\pm s$ 分组 n 内翻角/(°) 后倾角/(°) 术前 观察组 23 103.2±3.2 17.5±2.4 对照组 23 102.6±2.1 16.9±2.2 t - 0.75 0.90 P - >0.05 >0.05 术后 观察组 23 84.7±3.3** 10.6±1.2** 对照组 23 85.3±4.1** 10.5±1.1** t - 0.55 0.29 P - >0.05 >0.05 组内配对t检验:**P < 0.01 表 3 2组术后6个月及18个月Rasmussen放射学及HSS膝关节功能评分比较
分组 n HSS评分/分 Rasmussen评分/分 术后6个月 观察组 23 87.9±12.0 16.2±1.7 对照组 23 85.4±12.8 15.7±2.1 t - 0.68 0.89 P - >0.05 >0.05 术后18个月 观察组 23 85.9±12.9 15.8±2.1 对照组 23 85.5±12.3 14.5±2.3 t - 0.11 2.00 P - >0.05 >0.05 -
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