双切口双钢板内固定与单侧锁定钢板内固定治疗复杂胫骨平台骨折的效果比较
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摘要
目的:对比双切口双钢板内固定与单侧锁定钢板内固定治疗复杂胫骨平台骨折(complex tibial plateau fracture,CTPF)的效果。方法:选取2014年9月-2018年1月于本院进行治疗的58例复杂胫骨平台骨折患者作为研究对象,根据治疗方法的差异分为对照组和研究组,各29例。对照组采取双切口双钢板内固定治疗,研究组实施单侧锁定钢板内固定治疗。对比两组患者疼痛程度、手术相关指标、术后恢复情况。结果:术后3 d、10 d、1个月,研究组的VAS评分均低于对照组,差异均有统计学意义(P<0.05)。两组患者的手术时间、切口长度与术后出血量比较,差异均无统计学意义(P>0.05);而研究组的负重时间与愈合时间均短于对照组,差异均有统计学意义(P<0.05)。术后1个月,研究组HSS、BBS评分均明显高于对照组,差异均有统计学意义(P<0.05)。术后12个月,研究组的TPA与PA均明显优于对照组,差异均有统计学意义(P<0.05)。结论:针对复杂胫骨平台骨折患者,双切口双钢板内固定与单侧锁定钢板内固定治疗均能够取得较为理想的效果,但单侧锁定钢板内固定治疗在负重时间与愈合时间上均优于双切口双钢板内固定治疗,且患者疼痛情况较低,膝关节功能和活动度较为理想,值得应用。
Objective:To compare the effect of internal fixation with double incision double plate and unilateral locking plate in complex tibial plateau fracture(CTPF).Method:58 patients with complex tibial plateau fractures who were treated in our hospital from September 2014 to January 2018 were selected as the research objects.According to the difference of treatment methods,the patients were divided into control group and study group,29 cases in each group.The control group was treated with double incision double plate,the study group was treated with unilateral locking plate.The pain degree,surgical indicators and postoperative recovery were compared.Result:At 3 d,10 d and 1 month after surgery,VAS scores in the study group were lower than those in the control group,the differences were statistically significant(P<0.05).There were no significant differences in the operative time,incision length and postoperative blood loss between the two groups(P>0.05);the loading time and healing time in the study group were both shorter than those in the control group,with statistically significant differences(P<0.05).1 month after surgery,HSS and BBS scores of the study group were significantly higher than those of the control group,the differences were statistically significant(P<0.05).12 months after surgery,TPA and PA in the study group were significantly better than those in the control group,the differences were statistically significant(P<0.05).Conclusion:Both of the therapies have the favorable effect in CTPF patients,however,the unilateral locking plate can better shorten the weight-loading time and healing time,relieve the pain degree and improve the knee joint function and range of motion.It is worthy of application.
Objective:To compare the effect of internal fixation with double incision double plate and unilateral locking plate in complex tibial plateau fracture(CTPF).Method:58 patients with complex tibial plateau fractures who were treated in our hospital from September 2014 to January 2018 were selected as the research objects.According to the difference of treatment methods,the patients were divided into control group and study group,29 cases in each group.The control group was treated with double incision double plate,the study group was treated with unilateral locking plate.The pain degree,surgical indicators and postoperative recovery were compared.Result:At 3 d,10 d and 1 month after surgery,VAS scores in the study group were lower than those in the control group,the differences were statistically significant(P<0.05).There were no significant differences in the operative time,incision length and postoperative blood loss between the two groups(P>0.05);the loading time and healing time in the study group were both shorter than those in the control group,with statistically significant differences(P<0.05).1 month after surgery,HSS and BBS scores of the study group were significantly higher than those of the control group,the differences were statistically significant(P<0.05).12 months after surgery,TPA and PA in the study group were significantly better than those in the control group,the differences were statistically significant(P<0.05).Conclusion:Both of the therapies have the favorable effect in CTPF patients,however,the unilateral locking plate can better shorten the weight-loading time and healing time,relieve the pain degree and improve the knee joint function and range of motion.It is worthy of application.
引文
[1]罗东斌,张永,汤永南,等.双切口双钢板内固定与单侧锁定钢板内固定治疗复杂胫骨平台骨折的疗效比较[J].中国老年学杂志,2016,36(6):1413-1415.
[2]沈建明,汪军.对复杂胫骨平台骨折患者行双切口外侧高尔夫型、内侧小钢板植入内固定疗效分析[J].中国急救医学,2017,37(z2):128-129.
[3]周百刚,冯宏伟,贺西京,等.内外固定结合与双侧钢板内固定治疗复杂胫骨平台骨折的临床对比研究[J].中国现代医学杂志,2017,27(28):106-109.
[4]刘云鹏,刘沂.骨与关节损伤疾病的诊断及功能评定标准[M].北京:清华大学出版社,2002.
[5]陈农,马易群,周凯华,等.临时跨关节外固定支架固定联合延期内固定治疗复杂胫骨平台骨折[J].中华创伤骨科杂志,2016,18(4):312-317.
[6]崔龙慷,王晓洛,刘全,等.膝后内侧倒L形切口联合前外侧纵形切口钢板内固定治疗复杂胫骨平台骨折[J].中医正骨,2018,30(7):58-61.
[7]戴勇,崔崟,王秀会,等.前外侧联合后内侧手术入路双钢板并植骨治疗复杂胫骨平台骨折[J].生物骨科材料与临床研究,2016,13(2):51-54.
[8]Prasad A K,Rashid M,Heidari N.novel use of an external fixator connecting rod and synthetic bone substitute to achieve anatomic reduction of depressed tibial plateau fracture fragments[J].Annals of the Royal College of Surgeons of England,2015,97(1):78.
[9]邓介超,丛云海,朱治国,等.3D打印在治疗复杂胫骨平台骨折制定术前计划中的应用价值[J].临床和实验医学杂志,2018,17(21):2336-2339.
[10]朱剑,朱志军,叶峥,等.前外侧锁定加压钢板结合后内侧有限切开小型锁定钢板短螺钉治疗复杂胫骨平台骨折[J].中华创伤骨科杂志,2016,18(10):863-868.
[11]张擎柱,张义,何志勇,等.可视三窗口的改良后内侧倒“L”入路治疗复杂胫骨平台骨折19例临床观察[J].临床误诊误治,2018,31(10):37-41.
[12]van de Pol G J,Iselin L D,Callary S A,et al.Impaction bone grafting has potential as an adjunct to the surgical stabilisation of osteoporotic tibial plateau fractures:Early results of a case series[J].Injury,2015,46(6):1089-1096.
[13]马腾,魏代好,秦悦,等.常规影像学结合3D打印技术在复杂胫骨平台骨折治疗中的应用[J].宁夏医科大学学报,2017,39(12):1452-1454,1506.
[14]邱伟建,包德明,王驭恺,等.后内侧倒“L”形切口联合前外侧切口治疗复杂胫骨平台骨折[J].中华创伤骨科杂志,2016,18(10):840-844.
[15]丁浩亮,薛子超,胡传真,等.后内侧联合前外侧入路复位固定治疗后外侧关节面塌陷的复杂胫骨平台骨折[J].中华创伤骨科杂志,2015,17(7):559-564.
[16]任戈亮,余承保,朱玉洲,等.双切口3至4块钢板固定治疗累及后内侧柱的复杂胫骨平台骨折15例疗效分析[J].安徽医药,2018,22(8):1548-1550.
[17]杨光煦,刘启圣,欧阳传炜,等.膝内外侧双切口双钢板内固定治疗复杂胫骨平台骨折的效果分析[J].创伤外科杂志,2017,19(1):26-29.
[18]袁功武,聂宇,刘曦明,等.3D打印技术辅助治疗与传统手术方法治疗复杂胫骨平台骨折的对比研究[J].创伤外科杂志,2018,20(5):324-328.
[19]周力,李宇能,朱仕文,等.一期减张内固定与延迟手术治疗复杂胫骨平台骨折合并筋膜间隔综合征的比较研究[J].中华创伤骨科杂志,2018,20(5):394-399.
[20]苗本宽,余润泽.不同手术方式在最佳时间内对复杂性胫骨平台骨折合并膝关节周围软组织损伤的疗效[J].中国医药导报,2018,15(6):75-79.
[2]沈建明,汪军.对复杂胫骨平台骨折患者行双切口外侧高尔夫型、内侧小钢板植入内固定疗效分析[J].中国急救医学,2017,37(z2):128-129.
[3]周百刚,冯宏伟,贺西京,等.内外固定结合与双侧钢板内固定治疗复杂胫骨平台骨折的临床对比研究[J].中国现代医学杂志,2017,27(28):106-109.
[4]刘云鹏,刘沂.骨与关节损伤疾病的诊断及功能评定标准[M].北京:清华大学出版社,2002.
[5]陈农,马易群,周凯华,等.临时跨关节外固定支架固定联合延期内固定治疗复杂胫骨平台骨折[J].中华创伤骨科杂志,2016,18(4):312-317.
[6]崔龙慷,王晓洛,刘全,等.膝后内侧倒L形切口联合前外侧纵形切口钢板内固定治疗复杂胫骨平台骨折[J].中医正骨,2018,30(7):58-61.
[7]戴勇,崔崟,王秀会,等.前外侧联合后内侧手术入路双钢板并植骨治疗复杂胫骨平台骨折[J].生物骨科材料与临床研究,2016,13(2):51-54.
[8]Prasad A K,Rashid M,Heidari N.novel use of an external fixator connecting rod and synthetic bone substitute to achieve anatomic reduction of depressed tibial plateau fracture fragments[J].Annals of the Royal College of Surgeons of England,2015,97(1):78.
[9]邓介超,丛云海,朱治国,等.3D打印在治疗复杂胫骨平台骨折制定术前计划中的应用价值[J].临床和实验医学杂志,2018,17(21):2336-2339.
[10]朱剑,朱志军,叶峥,等.前外侧锁定加压钢板结合后内侧有限切开小型锁定钢板短螺钉治疗复杂胫骨平台骨折[J].中华创伤骨科杂志,2016,18(10):863-868.
[11]张擎柱,张义,何志勇,等.可视三窗口的改良后内侧倒“L”入路治疗复杂胫骨平台骨折19例临床观察[J].临床误诊误治,2018,31(10):37-41.
[12]van de Pol G J,Iselin L D,Callary S A,et al.Impaction bone grafting has potential as an adjunct to the surgical stabilisation of osteoporotic tibial plateau fractures:Early results of a case series[J].Injury,2015,46(6):1089-1096.
[13]马腾,魏代好,秦悦,等.常规影像学结合3D打印技术在复杂胫骨平台骨折治疗中的应用[J].宁夏医科大学学报,2017,39(12):1452-1454,1506.
[14]邱伟建,包德明,王驭恺,等.后内侧倒“L”形切口联合前外侧切口治疗复杂胫骨平台骨折[J].中华创伤骨科杂志,2016,18(10):840-844.
[15]丁浩亮,薛子超,胡传真,等.后内侧联合前外侧入路复位固定治疗后外侧关节面塌陷的复杂胫骨平台骨折[J].中华创伤骨科杂志,2015,17(7):559-564.
[16]任戈亮,余承保,朱玉洲,等.双切口3至4块钢板固定治疗累及后内侧柱的复杂胫骨平台骨折15例疗效分析[J].安徽医药,2018,22(8):1548-1550.
[17]杨光煦,刘启圣,欧阳传炜,等.膝内外侧双切口双钢板内固定治疗复杂胫骨平台骨折的效果分析[J].创伤外科杂志,2017,19(1):26-29.
[18]袁功武,聂宇,刘曦明,等.3D打印技术辅助治疗与传统手术方法治疗复杂胫骨平台骨折的对比研究[J].创伤外科杂志,2018,20(5):324-328.
[19]周力,李宇能,朱仕文,等.一期减张内固定与延迟手术治疗复杂胫骨平台骨折合并筋膜间隔综合征的比较研究[J].中华创伤骨科杂志,2018,20(5):394-399.
[20]苗本宽,余润泽.不同手术方式在最佳时间内对复杂性胫骨平台骨折合并膝关节周围软组织损伤的疗效[J].中国医药导报,2018,15(6):75-79.