摘要
目的分析膝前后联合入路手术治疗复杂过伸型胫骨平台骨折的安全性与有效性。方法2015年2月~2020年2月我院创伤骨科收治的复杂过伸型胫骨平台骨折病人92例,联合组48例,接受膝前后联合入路手术治疗,正中组44例,接受传统膝前正中入路手术治疗。比较两组病人围手术期情况、随访期指标及影像学指标。结果联合组病人术中出血量、射线曝光时间、术后引流量及住院时间等围手术期指标均低于正中组,差异有统计学意义(P<0.05)。末次随访时,联合组病人的不良反应发生率低于正中组,差异有统计学意义(6.82%vs.13.16%,P<0.05)。术后3个月及末次随访时,联合组和正中组膝关节美国特种外科医院(hospital for special surgery,HSS)评分分别为(64.57±0.47)分和(56.39±0.46)分,Rasmussen评分分别为(16.42±0.46)分和(12.39±0.41)分,两组比较差异有统计学意义(P<0.05);末次随访时,联合组和正中组病人内翻角分别为(84.16±4.89)°和(89.14±6.78)°,股胫角分别为(176.64±4.21)°和(167.65±3.83)°,后倾角分别为(11.54±0.79)°和(9.65±0.83)°,两组比较差异有统计学意义(P<0.05)。结论联合入路手术治疗复杂过伸型胫骨平台骨折在恢复膝关节功能、缓解疼痛症状、促进骨折愈合、尽可能避免手术创伤对康复的影响等方面具有满意的疗效。
Objective To analyze the safety and effectiveness of combined anterior and posterior knee approach in the treatment of complex hyperextension tibial plateau fractures.Methods 92 patients with complex hyperextension tibial plateau fractures treated in the department of trauma and orthopedics of our hospital from February 2015 to February 2020 were analyzed retrospectively.The patients in the combined group received combined anterior and posterior knee approach(48 cases),and the patients in the central group received traditional anterior and median knee approach(44 cases).The perioperative conditions,follow-up indexes and imaging evaluation in 2 groups were recorded and compared.Results The perioperative indicators such as intraoperative blood loss,radiation exposure time,postoperative drainage volume and hospital stay in the combined group were significantly lower than those in the median group(P<0.05).At the last follow-up,the incidence of adverse reactions in the combined group was significantly lower than that in the median group(6.82%vs.13.16%,P<0.05).At 3 months after operation and at the last follow-up,the hospital for special surgery(HSS)score of the knee joint[(64.57±0.47)vs.(56.39±0.46)]and Rasmussen score[(16.42±0.46)vs.(12.39±0.41)]in the combined group was safe than the median group(both P<0.05).At the last follow-up,the improvement of tibial plateau imaging indexes such as varus angle[(84.16±4.89)°vs.(89.14±6.78)°],femoral tibial angle[(176.64±4.21)°vs.(167.65±3.83)°]and posterior dip angle[(11.54±0.79)°vs.(9.65±0.83)°]in the combination group was significantly lower than that in the median group(P<0.05).Conclusion The combined approach in the treatment of complex hyperextension tibial plateau fractures has satisfactory curative effect in restoring knee function,alleviating pain symptoms,promoting fracture healing,reducing perioperative indicators and avoiding the impact of surgical trauma on rehabilitation as much as possible.
作者
管国义
刘晨
陈家麟
郑龙龙
GUAN Guoyi;LIUChen;CHEN Jialin(Department of Orthopedics,the First People’s Hospita of ChuZhou,AnHui Province,ChuZhou 239000,China;不详)
出处
《临床外科杂志》
2023年第4期326-329,共4页
Journal of Clinical Surgery
