摘要
目的探讨过伸双髁胫骨平台骨折(hyperextension bicondylar tibial plateau fractures,HEBTPs)的特点及其与非过伸双髁胫骨平台骨折(non-HEBTPs)的临床疗效比较。方法2014年6月至2017年5月共收集82例累及双髁的胫骨平台骨折患者,其中63例(63膝)患者(76.8%)为non-HEBTPs,19例(19膝,23.2%)为HEBTPs,男49例,女33例,年龄(48.3±10.9)岁(22~76岁)。19例HEBTPs中,4例为过伸外翻畸形,9例为过伸内翻畸形,6例为单纯过伸型损伤。均采用切开复位内固定结合植骨/或不植骨。评价HEBTPs组和non-HEBTPs组术前并发症发生率,术后感染、创伤性骨关节炎发生率,术后评估膝关节活动度,采用数字等级量表(numeric rating scale,NRS)评估疼痛程度,采用肌肉骨骼功能评估简表(short musculoskeletal function assessment,SMFA)评估功能,根据术后X线评估骨折愈合、膝关节力线。结果所有患者均获得随访,随访时间15.4个月(12~22个月)。骨折临床愈合时间12.6周(12~16周)。至末次随访,所有患者膝关节活动度正常,过伸双髁和非过伸双髁胫骨平台骨折术前并发症发病率分别为36.8%和15.8%,差异无统计学意义;19例HEBTPs组腘动脉损伤、腓总神经损伤和需要修复的韧带损伤的发生率分别为21.1%、26.3%和31.6%,而63例non-HEBTPs组相对应的合并症发生率分别为3.2%、4.8%和9.5%,差异均无统计学意义;HEBTPs组和non-HEBTPs组术后12个月NRS疼痛评分分别为(3.89±1.9)分和(2.76±1.88)分,差异无统计学意义;两组术后12个月SMFA得分为(27.27±19.44)分和(17.09±15.87)分,术后12个月HEBTPs患者SMFA得分高于non-HEBTPs患者,具有统计学意义,创伤后骨关节炎发生率高。结论过伸型胫骨平台骨折类型特殊,损伤程度不能低估,需要注意软组织损伤(韧带、血管与神经),治疗效果较差。
Objective To investigate the clinical features of patients with hyperextension bicondylar tibial plateau fractures(HEBTPs),and assess surgical effectiveness of HEBTP and non-HEBTP fracture patients.Methods From June 2014 to May 2017,82 patients with bicondylar tibial plateau fracture were included in this study.There were 63 patients with 63 knees(76.8%)that had sustained non-HEBTPs,and 19 patients with 19 knees(23.2%)that had HEBTPs,including 49 males and 33 females with a mean age of 48.3 years(range,22-76).Of the 19 HEBTPs patients,4 cases were hyperextension valgus injury,9 cases were hyperextension varus injury,and 6 cases were pure hyperextension injury.All patients were treated with open reduction internal fixation combined with bone grafting or non-bone grafting.All follow-up patients were evaluated clinically and radiographically,included the incidence of associated injuries,infection,posttraumatic osteoarthritis,range of motion(ROM)of knee,numeric rating scale(NRS)for assessment of pain,and Short Musculoskeletal Functional Assessment(SMFA)scores for assessment of knee function.The fracture healing and postoperative alignment were assessed with anteroposterior and lateral X-rays.Results All patients were followed up for 12-22 months,the mean follow-up time was 15.4 months.Bone union was obtained in all patients,and the bone union time was 12.6 weeks(ranged:12-16 weeks).At the last follow up,all patients had full range of motion.The incidence of significant associated injuries was 36.8%in the HEVBTP group compared with 15.8%in the non-HEBTP group.The incidence of popliteal artery injury,common peroneal nerve injury and ligament injury that needed repair in 19 HEBTPs patients was 21.1%,26.3%and 31.6%,respectively,while the corresponding incidence of complications in 63 non-HEBTPs patients was 3.2%,4.8%,and 9.5%,respectively.The NRS pain score of HEBTPs and non-HEBTPs at 12 months after surgery was 3.89±1.9 and 2.76±1.88,respectively.The value of HEBTPs patients was higher than that of non-HEBTPs patients
作者
魏学磊
鲁杰
卢艳东
崔猛
张玺
孙杰
Wei Xuelei;Lu Jie;Lu Yandong;Cui Meng;Zhang Xi;Sun Jie(Department of Orthopaedic Trauma,Tianjin Hospital,Tianjin 300211,China)
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2020年第2期65-72,共8页
Chinese Journal of Orthopaedics
基金
国家自然科学基金青年基金(81101358)。
关键词
胫骨骨折
对比研究
手术后并发症
预后
Tibial fractures
Comparative study
Postoperative complications
Prognosis
