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  

The efficacy of different surgical methods on the complicated tibial plateau fracture combined with soft tissue injury around the knee joint in the optimal time

作　　者：苗本宽 余润泽 MIAO Benkuan ,YU Runze(Department of Orthopaedics, Second People＇s Hospital of Anhui Province, Anhui Province, Hefei 340000, Chin)

机构地区：[1]安徽省第二人民医院骨科,安徽合肥340000

出　　处：《中国医药导报》2018年第6期75-79,共5页China Medical Herald

摘　　要：目的探讨不同术式在最佳时间内对复杂性胫骨平台合并膝关节周围软组织损伤的效果。方法回顾性分析安徽省第二人民医院在2013年10月~2017年9月收治的60例复杂胫骨平台患者的临床资料,按照治疗方法不同分为A组和B组,每组各30例。A组采用前内侧切口,B组采用前外侧和后内侧联合切口,均于骨折后6~7 d最佳手术时间内实施手术。观察并比较两组患者手术时间、术中平均出血量、术后感染率和引流量、切口愈合不良率、皮肤缺血坏死率及术后关节周围软组织恢复有效率。结果两组患者手术时间比较,差异无统计学意义(P>0.05);A组出血量、术后引流量均低于B组,差异有统计学意义(P<0.05);B组术后感染率、切口愈合不良率和皮肤缺血坏死发生率均低于A组,差异有统计学意义(P<0.05)。两组术后骨折愈合时间、内固定失败率及膝关节周围韧带恢复状况比较,差异均无统计学意义(P>0.05)。B组膝关节评分系统有效率高于A组,差异有统计学意义(P<0.05)。结论复杂胫骨平台骨折合并膝关节周围软组织损伤在伤后最佳时间内采用前外侧和后内侧联合切口术式,可促进患者快速康复,降低术后并发症发生率,值得临床进一步推广应用。Objective To investigate the efficacy of different surgical methods on the complicated tibial plateau fracture combined with soft tissue injury around the knee joint in the optimal time. Methods From October 2013 to September 2017, clinical data of 60 patients with complicated tibial plateau fracture combined with soft tissue injury around the knee joint treated in the Second People＇s Hospital of Anhui Province were retrospectively analyzed and divided into group A and group B by different surgical methods, with 30 cases in each group. Group A was treated with anteromedi- al incision and group B was treated with anterolateral combined with posterior medial incision, both performed 6-7 d after the fracture within the optimal timing. The operation time, average bleeding volume, incidence of postoperative in- fection, drainage volume, the incidences of the delayed healing, the skin necrosis and the postoperative soft tissue in- jury around the knee joint in the two groups were compared. Results There was no statistically significant difference in the operation time between the two groups （P 〉 0.05）; The average bleeding volume and postoperative drainage volume in group A were lower than those of group B, with statistically significant differences （P 〈 0.05）; the incidences of the de- layed healing, postoperative infection and skin necrosis in group B were lower than those of group A, with statistically significant differences （P 〈 0.05）. There were no statistically significant differences in the postoperative fracture healing time, incidence of internal fixation failure and recovery of ligaments around the knee between the two groups （P 〉 0.05）. The effective rate of knee joint scoring systom in group B was higher than that of group A, with statistically significant differences （P 〈 0.05）. Conclusion The anterolateral combined with posterior medial incisionin the optimal time can promote the recovery in patients with complicated tibial plateau fracture combined with soft tissue injury

关 键 词：复杂胫骨平台骨折 周围软组织损伤 内固定 康复锻炼 

分 类 号：R683.42[医药卫生—骨科学]