复杂胫骨平台骨折手术时机与手术方式的选择及疗效观察  

Timing and surgical procedures and corresponding curative effects of complex tibial plateau fractures operation

作　　者：张红岗 吴坚[1] 杨跃争 Zhang Honggang;Wu Jian;Yang Yuezheng(Department of Orthopaedics,Beijing Jishuitan Hospital,Beijing 100035,China;Department of Orthopaedics,Ruicheng People's Hospital,Ruicheng 044600,China)

机构地区：[1]北京积水潭医院骨科,100035 [2]山西省芮城县人民医院骨科,044600

出　　处：《中国实用医刊》2018年第23期52-54,共3页Chinese Journal of Practical Medicine

摘　　要：目的探讨复杂胫骨平台骨折手术时机、手术方式的选择及治疗效果。方法按照随机数字表法抽取北京积水潭医院2013年1月至2017年12月收治的复杂胫骨平台骨折患者52例为研究对象,按手术时间将其分为两组,每组26例。对照组(手术时间为伤后8d以上)接受膝前外侧单切口单钢板法治疗,观察组(手术时间为伤后6~8d)接受膝前正中切口双钢板法治疗。分析比较两组临床治疗情况。结果观察组手术时间[(150.49±25.14)min]、术中出血量[(305.71±25.68)m1]、住院时间[(10.27±2.31)d]、骨折愈合时间[(119.32±18.54)d]、Harris评分[(86.10-I-2.95)分]均优于对照组[(268.02±21.56)min、(297.31±24.15)ml、(15.84±3.25)d、(157.96±20.36)d、(72.35±5.70)分],差异有统计学意义(P<0.05);观察组并发症发生率(11.5%)低于对照组(42.3%),差异有统计学意义(P<0.05)。结论复杂胫骨平台骨折患者应于伤后6~8d接受手术治疗,膝前正中切口双钢板法治疗的效果优于膝前外侧单切口单钢板法,患者切口愈合、感染、皮肤坏死等软组织情况均佳,可作为复杂胫骨平台骨折临床治疗的首选方案。Objective To investigate the operative timing,surgical procedures and curative effects of complex tibial plateau fracture operation.Methods Fifty-two patients with complex tibial plateau fractures admitted to Beijing Jishuitan Hospital from January 2013 to December 2017 were selected by random number table method.They were divided into two groups according to the operation times.Patients in the control group (underwent operation more than 8d after injury)were treated by steel plate with single anterolateral incision of the knee,and patients in observation group (underwent operation 6-8d after injury)were treated by double plate method with anterior median incision of the knee,and the clinical treatment condition of the two groups was compared.Results The operative time [(150.49±25.14)min ],intraoperative bleeding [(305.71±25.68)ml],hospitalization time [(10.27±2.31)d ],fracture healing time [(119.32±18.54)d]and Harris score (86.10±2.95)of observation group were better than those of control group [(268.02±21.56)min,(297.31±24.15)ml, (15.84±3.25)d,(157.96±20.36)d,72.35±5.70],P <0.05;the incidence of total complications in observation group (11.5%)was lower than that in control group (42.3%),P<0.05. Conclusions Patients with complex tibial plateau fractures should undergo surgery at 6-8d after injury.The effect of double plate method with anterior median incision of the knee is superior to that of single anterolateral incision of the knee.This method can be used as the first choice for clinical treatment of complex tibial plateau fractures.

关 键 词：复杂胫骨平台骨折 手术时机 手术方式 

分 类 号：R687.3[医药卫生—骨科学]