摘要
目的比较前外联合后内侧入路与单一后侧倒"L"形入路复位内固定治疗伴冠状面半脱位的Wahlquist C型内侧胫骨平台骨折(medial tibial plateau fracture,mTPF)的疗效。方法回顾性分析2010年1月至2021年4月手术治疗的44例Wahlquist C型mTPF患者资料,按手术入路分为单一后侧倒"L"形入路(简称单一入路组)和前外联合后内侧入路(简称联合入路组)。单一入路组21例,男12例、女9例;年龄(50.71±11.28)岁;左侧14例、右侧7例;骨折位于前内+后内+后外象限19例、后内+后外象限2例。联合入路组23例,男16例、女7例;年龄(51.00±10.07)岁;左侧18例、右侧5例;骨折位于前内+后内+后外象限22例、后内+后外象限1例。比较两组患者的术中出血量、术后半脱位率和复位不良率、输血事件发生率、胫骨平台近端内侧角和后倾角;采用肌肉骨骼功能评估简表(short musculoskeletal function assessment,SMFA)和视觉模拟评分(visual analogue scale,VAS)评估术后功能和疼痛。结果术中出血量联合入路组为(597.83±89.79)ml,单一入路组为(516.67±79.58)ml,差异有统计学意义(t=3.16,P=0.003)。联合入路组输血事件发生率为17%(4/23),单一入路组为14%(3/21),差异无统计学意义(χ^(2)=0.08,P=0.78)。44例患者均获得随访,随访时间8~133个月,平均54个月。联合入路组术后膝关节半脱位率和骨折复位不良率均低于单一入路组(34.8%vs.76.2%,χ^(2)=7.59,P=0.006;30.4%vs.61.9%,χ^(2)=4.39,P=0.036)。两组术后胫骨平台近端内侧角和后倾角相近(86.67°±3.31°vs.85.86°±4.36°,t=0.88,P=0.386;81.57°±3.22°vs.83.90°±6.80°,t=1.44,P=0.162)。联合入路组术后SMFA和VAS评分分别为(20.52±11.04)分和(2.74±1.32)分,单一入路组分别为(31.19±16.79)分和(3.76±1.04)分,联合入路组疗效更佳(t=2.51,P=0.016;t=3.13,P=0.007)。结论采用前外联合后内侧入路复位内固定治疗伴冠状面半脱位的Wahlquist C型mTPF的疗效优于单一后侧倒"L"形入路�
Objective To compare the efficacy of posteromedial and anterolateral approach and single posteromedial reversed L approach for reduction and internal fixation in the treatment of Wahlquist type C medial tibial plateau fracture(mTPF)with coronal subluxation of knee joint.Methods A retrospective analysis was conducted on 44 surgically treated Wahlquist type C mTPFs from January 2010 to April 2021.They were divided into single-approach group(21 cases,12 males and 9 females with mean age of 50.71±11.28 years)and combined-approach group(23 cases,16 males and 7 females with mean age of 51.00±10.07 years)according to their surgical approach.The single-approach group contained 14 left limbs and 7 right limbs,and there were 19 anteromedial-posteromedial-posterolateral mTPF and 2 posteromedial-posterolateral mTPF.The combined-approach group contained 18 left limbs and 5 right limbs,and there were 22 anteromedial-posteromedial-posterolateral mTPF and 1 posteromedial-posterolateral mTPF.The intraoperative blood loss and incidence of blood transferring were assessed according to the anesthetic recording.The incidence of residual knee subluxation and articular surface step,medial proximal tibial angle(MPTA)and posterior proximal tibial angle(PPTA)were measured on the postoperative plain radiograph and the function recovery of the affected knee was evaluated by the short musculoskeletal function assessment(SMFA)and the visual analogue scale(VAS).Results The intraoperative blood loss in combined-approach group was 597.83±89.79 ml and 516.67±79.58 ml in single-approach group,there was a significant difference between the two groups(t=3.16,P=0.003).The incidence of blood transferring was 17%(4/23)in the combined-approach group and 14%(3/21)in the single-approach group,with no significant difference(χ^(2)=0.08,P=0.78).All 44 patients were followed up for 8 to 133 months(mean 54 months).The rate of the residual knee subluxation and unsatisfied articular surface reduction in the combined-approach group was lower than that in the
作者
张宇
胡军
洪顾麒
李翔
Zhang Yu;Hu Jun;Hong Guqi;Li Xiang(Department of Orthopaedic Trauma,the First Affiliated Hospital to Nanjing Medical University,Nanjing 210029,China)
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2022年第6期349-356,共8页
Chinese Journal of Orthopaedics
基金
国家自然科学基金(81672218)。
关键词
胫骨骨折
膝脱位
骨折固定术
内
Tibial fractures
Knee dislocation
Fracture fixation,internal
