改良前外侧入路治疗胫骨平台后外侧骨折的疗效
|
摘要
目的探讨改良前外侧入路治疗胫骨平台后外侧骨折的疗效。方法将112例胫骨平台后外侧骨折患者按照手术入路不同分为观察组(采用改良前外侧入路内固定治疗,56例)和对照组(采用后外侧入路内固定治疗,56例)。比较两组手术时间、术中出血量、切口愈合时间、骨折愈合时间、负重下地活动时间、膝关节屈曲活动度、膝关节功能和本体感觉恢复。结果两组患者均获得随访,时间12～36(15. 38±4. 37)个月。手术时间、术中出血量、切口愈合时间、骨折愈合时间和负重下地活动时间观察组明显短(少)于对照组(P <0. 01),膝关节屈曲活动度观察组大于对照组(P <0. 01)。术后6个月,HSS评分及膝关节30°、45°、60°时主动复位绝对误差角度两组比较差异均无统计学意义(P> 0. 05)。术后12个月,两组HSS评分较术后6个月明显升高(P <0. 01),膝关节30°、45°、60°时主动复位绝对误差角度较术后6个月明显降低(P <0. 01),观察组的升高或者降低水平较对照组更加明显(P <0. 01)。观察组膝关节功能恢复优良率为94. 64%,明显高于对照组的78. 57%(P <0. 05)。观察组的并发症发生率为5. 36%,明显低于对照组的19. 64%(P <0. 05)。结论改良前外侧入路治疗胫骨平台后外侧骨折的疗效优于后外侧入路,具有创伤小、恢复快、并发症少、对膝关节功能影响小等优势。
Objective To investigate the efficacy of modified anterolateral approach in patients with posterolateral tibial plateau fractures. Methods The 112 patients with posterolateral tibial plateau fractures were divided into observation group( internal fixation via modified anterolateral approach,56 cases) and control group( internal fixation via posterolateral approach,56 cases) accroding the surgical approach. The operation time,intraoperative blood loss,incision healing time,fracture healing time,weight-bearing activity time,knee flexion activity,knee function and proprioception recovery were compared between the two groups. Results All patients were followed up for 12 ～36( 15. 38 ± 4. 37) months. The operation time,intraoperative blood loss,wound healing time,fracture healing time and weight-bearing activity time in the observation group were significantly shorter( less) than those of the control group( P < 0. 01),and the knee flexion activity in the observation group was larger than that in the control group( P< 0. 01). At 6 months after operation,there were no significant differences in HSS scores and absolute error angle of knee joints active reduction at 30°,45° and 60°( P > 0. 05). At 12 months after operation,the HSS scores in two groups were significantly increased compared with that at 6 months postoperation( P < 0. 01),and the absolute error angle of knee joints active reduction at 30°,45° and 60° were significantly decreased compared with those at 6 months after operation( P < 0. 01),the decreasing or increasing levels in the observation group were more obvious compared with the control group( P < 0. 01). The excellent and good rate of knee joint function recovery in the observation group was 94. 64%,which was significantly higher than 78. 57% in the control group( P < 0. 05). The complication incidence rate was 5. 36% in the observation group,which was significantly lower than 19. 64% in the control group( P < 0. 05). Conclusions The efficacy of modified anterolateral approach on posterolateral tibial plateau fractures is better than that of posterolateral approach. It has the advantages of less trauma,quick recovery,fewer complications and less impact on knee function.
Objective To investigate the efficacy of modified anterolateral approach in patients with posterolateral tibial plateau fractures. Methods The 112 patients with posterolateral tibial plateau fractures were divided into observation group( internal fixation via modified anterolateral approach,56 cases) and control group( internal fixation via posterolateral approach,56 cases) accroding the surgical approach. The operation time,intraoperative blood loss,incision healing time,fracture healing time,weight-bearing activity time,knee flexion activity,knee function and proprioception recovery were compared between the two groups. Results All patients were followed up for 12 ～36( 15. 38 ± 4. 37) months. The operation time,intraoperative blood loss,wound healing time,fracture healing time and weight-bearing activity time in the observation group were significantly shorter( less) than those of the control group( P < 0. 01),and the knee flexion activity in the observation group was larger than that in the control group( P< 0. 01). At 6 months after operation,there were no significant differences in HSS scores and absolute error angle of knee joints active reduction at 30°,45° and 60°( P > 0. 05). At 12 months after operation,the HSS scores in two groups were significantly increased compared with that at 6 months postoperation( P < 0. 01),and the absolute error angle of knee joints active reduction at 30°,45° and 60° were significantly decreased compared with those at 6 months after operation( P < 0. 01),the decreasing or increasing levels in the observation group were more obvious compared with the control group( P < 0. 01). The excellent and good rate of knee joint function recovery in the observation group was 94. 64%,which was significantly higher than 78. 57% in the control group( P < 0. 05). The complication incidence rate was 5. 36% in the observation group,which was significantly lower than 19. 64% in the control group( P < 0. 05). Conclusions The efficacy of modified anterolateral approach on posterolateral tibial plateau fractures is better than that of posterolateral approach. It has the advantages of less trauma,quick recovery,fewer complications and less impact on knee function.
引文
[1]陈红卫,赵钢生,张根福,等.改良的前外侧入路治疗胫骨平台后外侧骨折[J].临床骨科杂志,2012,15(5):549-551.
[2]赵磊,葛建飞,王创利,等.前外侧入路锁定钢板固定治疗胫骨平台后外侧骨折的疗效[J].宁夏医科大学学报,2017,39(2):187-190.
[3]杨江伟,陈俞涛,王剑飞,等.后外侧倒“L”形入路治疗胫骨平台后外侧骨折的疗效观察[J].创伤外科杂志,2015,17(5):449-451.
[4]陈宏峰,甄相周,王亮,等.经腓骨后外侧入路治疗胫骨平台后外侧骨折[J].实用骨科杂志,2015,21(5):462-465.
[5] Cho J W,Samal P,Jeon Y S,et al. Rim plating of posterolateral fracture fragments(PLFs)through a modified anterolateral approach in tibial plateau fractures[J]. J Orthop Trauma,2016,30(11):e362-e368.
[6]张建华,李玉前,王晓东,等.改良的后外侧入路治疗胫骨平台后外侧髁骨折22例临床分析[J].南通大学学报(医学版),2014,34(1):69-71.
[7]徐国健,翁东,谢明华,等.改良前外侧入路治疗胫骨平台后外侧塌陷骨折[J].中国骨伤,2015,28(3):256-259.
[8]何建华.改良前外侧入路胫骨近端锁定加压钢板固定治疗胫骨平台后外侧骨折[J].中国煤炭工业医学杂志,2015,18(1):86-89.
[2]赵磊,葛建飞,王创利,等.前外侧入路锁定钢板固定治疗胫骨平台后外侧骨折的疗效[J].宁夏医科大学学报,2017,39(2):187-190.
[3]杨江伟,陈俞涛,王剑飞,等.后外侧倒“L”形入路治疗胫骨平台后外侧骨折的疗效观察[J].创伤外科杂志,2015,17(5):449-451.
[4]陈宏峰,甄相周,王亮,等.经腓骨后外侧入路治疗胫骨平台后外侧骨折[J].实用骨科杂志,2015,21(5):462-465.
[5] Cho J W,Samal P,Jeon Y S,et al. Rim plating of posterolateral fracture fragments(PLFs)through a modified anterolateral approach in tibial plateau fractures[J]. J Orthop Trauma,2016,30(11):e362-e368.
[6]张建华,李玉前,王晓东,等.改良的后外侧入路治疗胫骨平台后外侧髁骨折22例临床分析[J].南通大学学报(医学版),2014,34(1):69-71.
[7]徐国健,翁东,谢明华,等.改良前外侧入路治疗胫骨平台后外侧塌陷骨折[J].中国骨伤,2015,28(3):256-259.
[8]何建华.改良前外侧入路胫骨近端锁定加压钢板固定治疗胫骨平台后外侧骨折[J].中国煤炭工业医学杂志,2015,18(1):86-89.
© 2004-2018 中国地质图书馆版权所有 京ICP备05064691号 京公网安备11010802017129号 地址：北京市海淀区学院路29号 邮编：100083 电话：办公室：(+86 10)66554848；文献借阅、咨询服务、科技查新：66554700 |