摘要
目的比较改良双窗与传统单窗膝关节后内侧倒“L”形入路复位内固定治疗屈曲内翻型胫骨平台骨折的疗效。方法采用回顾性队列研究分析2018年1月至2022年12月南京医科大学附属常州第二人民医院收治的44例屈曲内翻型胫骨平台骨折患者的临床资料,其中男22例,女22例;年龄31~58岁[(44.4±9.1)岁]。左侧25例,右侧19例。23例行传统单窗后内侧倒“L”形入路复位内固定(传统单窗入路组),21例行改良双窗后内侧倒“L”形入路复位内固定(改良双窗入路组)。比较两组手术切口长度、手术时间、术中出血量、术后引流量、术后住院时间;术后3 d、3个月及末次随访时关节面塌陷距离、胫骨平台内翻角(mTPA)、胫骨平台后倾角(PSA)及Rasmussen放射学评分;术前、术后7 d及3个月视觉模拟评分(VAS);术后7 d膝关节伸屈活动度;术后3、6个月及末次随访时美国特种外科医院(HSS)膝关节功能评分。末次随访时观察骨折愈合情况。比较两组术后血栓形成、切口愈合不良等并发症发生率。结果患者均获随访12~18个月[(15.7±3.2)个月]。改良双窗入路组手术时间为(121.6±19.2)min,短于传统单窗入路组的(149.5±22.4)min(P<0.01)。两组手术切口长度、术中出血量、术后引流量、术后住院时间差异均无统计学意义(P>0.05)。术后3 d、3个月及末次随访时,改良双窗入路组关节面塌陷距离分别为0.7(0.5,0.9)mm、1.0(0.8,1.1)mm、0.9(0.8,1.0)mm,均短于传统单窗入路组的1.0(0.7,1.2)mm、1.1(1.0,1.3)mm、1.1(0.9,1.2)mm(P<0.05或0.01);改良双窗入路组mTPA分别为87.0(86.0,87.0)°、87.0(86.0,87.0)°、86.0(85.5,87.0)°,均大于传统单窗入路组的85.0(84.0,86.0)°、85.0(84.0,86.0)°、85.0(84.0,86.0)°(P<0.01);改良双窗入路组Rasmussen放射学评分分别为(17.0±0.9)分、16.0(15.0,17.0)分、16.0(15.0,16.0)分,均高于传统单窗入路组的(16.4±1.1)分、13.0(13.0,15.0)分、14.0(13.0,15.0)分(P<0.05或0.01);两组PSA差异均无统计学意义(P>0.05)。术前两组VAS差异无统计学意义(P>0.05);术后7 d,改良双窗入路组VAS为3.0(3.0,3.0)分,低于传统单窗入路组的3.0(3.0,4.0)分(P<0.05);术后3个月,两组VAS差异无统计学意义(P>0.05)。术后7 d,改良双窗入路组膝关节伸屈活动度为90.0(85.0,95.0)°,大于传统单窗入路组的80.0(75.0,85.0)°(P<0.01)。术后3个月,改良双窗入路组HSS膝关节功能评分为(67.9±2.8)分,高于传统单窗入路组的(66.1±2.7)分(P<0.05);术后6个月及末次随访时,两组HSS膝关节功能评分差异均无统计学意义(P>0.05)。末次随访时两组骨折均骨性愈合。传统单窗入路组1例术后腘静脉部分血栓形成,并发症发生率为4.4%(1/23),改良双窗入路组1例术后切口愈合不良,并发症发生率为4.8%(1/21)(P>0.05)。结论与传统单窗入路相比,改良双窗膝关节后内侧倒“L”形入路复位内固定治疗屈曲内翻型胫骨平台骨折能缩短手术时间,提高骨折复位质量,早期缓解疼痛、改善膝关节伸屈活动度及关节功能。
Objective To compare the efficacy of reduction and internal fixation of flexion⁃inversion tibial plateau fractures with a modified two⁃window and conventional single⁃window posteromedial inverted L⁃shaped approach.Methods A retrospective cohort study was used to analyze the clinical data of 44 patients with flexion⁃inversion tibial plateau fractures admitted to the Affiliated Changzhou No.2 People′s Hospital of Nanjing Medical University from January 2018 to December 2022,including 22 males and 22 females,aged 31⁃58 years[(44.4±9.1)years].Among them,25 patients were injured on the left side and 19 on the right.A total of 23 patients were treated with the conventional single⁃window posteromedial inverted L⁃shaped approach(conventional single⁃window approach group),while the other 21 with the modified two⁃window posteromedial inverted L⁃shaped approach(modified two⁃window approach group).The length of surgical incision,operation time,intraoperative blood loss,postoperative drainage volume,and postoperative hospital stay were compared between the two groups.The articular step⁃offs,medial tibial plateau angles(mTPA),tibial posterior slope angles(PSA),and Rasmussen radiological scores at 3 days,3 months after surgery and at the last follow⁃up were evaluated in the two groups.The visual analogue scale(VAS)scores before surgery,at 7 days and 3 months after surgery,data of extension⁃flexion motion of the knee joint at 7 days after surgery and Hospital for Special Surgery(HSS)knee function scores at 3 and 6 months after surgery and at the last follow⁃up were compared between the two groups.At the last follow⁃up,the fracture healing was observed.The postoperative incidence of complications such as thrombosis and poor wound healing was compared between the two groups.Results All the patients were followed up for 12⁃18 months[(15.7±3.2)months].The operation time of the modified two⁃window approach group was(121.6±19.2)minutes,significantly shorter than(149.5±22.4)minutes of the conventional single⁃window approach group(P<0.01).There were no statistically significant differences in the length of surgical incision,intraoperative blood loss,postoperative drainage volume,or postoperative hospital stay between the two groups(P>0.05).At 3 days,3 months after surgery and at the last follow⁃up,the articular step⁃offs of the modified two⁃window approach group were 0.7(0.5,0.9)mm,1.0(0.8,1.1)mm and 0.9(0.8,1.0)mm respectively,significantly shorter than 1.0(0.7,1.2)mm,1.1(1.0,1.3)mm and 1.1(0.9,1.2)mm of the conventional single⁃window approach group(P<0.05 or 0.01);the mTPA of the modified two⁃window approach group was 87.0(86.0,87.0)°,87.0(86.0,87.0)°and 86.0(85.5,87.0)°respectively,significantly larger than 85.0(84.0,86.0)°,85.0(84.0,86.0)°and 85.0(84.0,86.0)°of the conventional single⁃window approach group(P<0.01);the Rasmussen radiological scores of the modified two⁃window approach group were(17.0±0.9)points,16.0(15.0,17.0)points and 16.0(15.0,16.0)points respectively,significantly higher than(16.4±1.1)points,13.0(13.0,15.0)points and 14.0(13.0,15.0)points of the conventional single⁃window approach group(P<0.05 or 0.01);no significant differences in the PSA were found between the two groups(P>0.05).There were no significant differences in VAS scores between the two groups before surgery and at 3 months after surgery(P>0.05),while the VAS score at 7 days after surgery was 3.0(3.0,3.0)points in the modified two⁃window approach group,significantly lower than 3.0(3.0,4.0)points of the conventional single⁃window approach group(P<0.05).There was no significant difference in the VAS score at 3 months after surgery between the two groups(P>0.05).The extension⁃flexion motion of the knee joint at 7 days after surgery was 90.0(85.0,95.0)°in the modified two⁃window approach group,higher than 80.0(75.0,85.0)°of the conventional single⁃window approach group(P<0.01).The HSS knee function score at 3 months after surgery was(67.9±2.8)points in the modified two⁃window approach group,higher than(66.1±2.7)points of the conventional one⁃window approach group(P<0.05).There were no significant differences in the HSS knee function scores at 6 months after surgery and at the last follow⁃up between the two groups(P>0.05).At the last follow⁃up,bone union was observed in both groups.One patient in the conventional single⁃window approach group developed partial popliteal vein thrombosis,with a complication rate of 4.4%(1/23);while one patient in the modified two⁃window approach group had poor healing of the incision postoperatively,with a complication rate of 4.8%(1/21)(P>0.05).Conclusion Compared with the conventional single⁃window approach,the modified two⁃window posteromedial inverted L⁃shaped approach has the advantages of shorter operation time,better reduction quality,early pain relief,and better restoration of knee joint extension⁃flexion motion and joint function in the reduction and internal fixation of flexion⁃inversion tibial plateau fractures.
作者
刘志元
周维波
黄建峰
陈伟
周福临
Liu Zhiyuan;Zhou Weibo;Huang Jianfeng;Chen Wei;Zhou Fulin(Department of Orthopedics,Changzhou Wujin People′s Hospital,Changzhou 213017,China;Department of Orthopedics,Affiliated Changzhou Second People′s Hospital of Nanjing Medical University,Changzhou 213000,China)
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2024年第9期793-800,共8页
Chinese Journal of Trauma
基金
江苏省卫生健康委员会指导性项目(Z2022045)
常州市科技局应用基础研究计划(CJ20220010,CJ20230070)。
关键词
胫骨骨折
骨折固定术
内
手术入路
Tibial fractures
Fracture fixation,internal
Surgical approach
