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  

Comparison of primary decompressive internal fixation versus delayed surgery for tibial plateau fractures combined with compartment syndrome

作　　者：周力[1] 李宇能[1] 朱仕文[1] 吴新宝[1] Zhou Li;Li Yuneng;Zhu Shiwen;Wu Xinbao(Department of Orthopaedics, Beijing Jishuitan Hospital, Beijing 100035, China)

机构地区：[1]北京积水潭医院创伤骨科,100035

出　　处：《中华创伤骨科杂志》2018年第5期394-399,共6页Chinese Journal of Orthopaedic Trauma

基　　金：首都卫生发展科研专项-重点攻关项目（首发2016-1-2071）

摘　　要：目的 比较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疗效. 方法 对2012年1月至2014年6月接受手术治疗的39例胫骨平台骨折合并筋膜间隔综合征患者资料进行回顾性研究,根据手术方式分为早期固定组和延迟手术组,其中早期固定组患者18例,手术方式均为一期小腿内外侧入路切开减张联合钢板螺钉内固定,软组织情况好转后二期植皮或缝合伤口;延迟手术组患者21例,于急诊行外固定支架固定、小腿内外侧入路切开减张后,择期行切开复位内固定术.比较两组患者手术及住院相关指标、末次随访时Lysholm评分和欧洲五维健康量表（EQ-5D）、疼痛视觉模拟评分（VAS）. 结果 所有患者术后均获2年以上随访.早期固定组患者手术时间（229.1±43.7）min、术中出血量（297.5±51.5） mL、住院时间（11.9±1.9）d、住院费用[14.47（10.32,17.99）万元]明显低于延迟手术组[（322.1±62.2） min、（385.9±56.4） mL、（21.5±3.6）d、19.77（13.72,23.43）万元],差异均有统计学意义（P＜0.05）.两组并发症发生率分别为22.2％（4/18）和38.1％ （8/21）、骨折愈合时间分别为（6.1±1.1）个月和（5.8±1.4）个月,末次随访时Lysholm评分分别为（83.9±9.7）分和（81.1±12.3）分,EQ-5D指数分别为0.85±0.09和0.84±0.12,VAS评分为（1.3±1.2）分和（1.5±1.4）分,以上比较差异均无统计学意义（P＞0.05）. 结论 一期减张内固定与延迟手术治疗胫骨平台骨折合并筋膜间隔综合征均可取得满意的临床疗效,一期手术更适合于尚无明显肢体缺血症状的患者,已出现严重筋膜间隔综合征的患者应以保肢为目的,更适合延迟手术,医生应严格把握适应证,根据患者具体情况合理选择手术方式.Objective To evaluate the clinical outcomes of primary decompressive internal fixation versus delayed surgery for tibial plateau fractures combined with compartment syndrome.Methods From January 2012 to June 2014,a total of 39 patients were treated at our department for tibial plateau fracture combined with compartment syndrome.Early operation was adopted for 18 patients in whom decompression by incisions via the medial and lateral approaches combined with internal fixation with plate and screws was performed at the primary stage and dermoplasty or wound closure conducted at the secondary stage after conditions of soft tissue allowed.Delayed operation was adopted for 21 patients in whom external fixation and decompression by incisions via the medial and lateral approaches was performed in the emergency management followed by selective open reduction and internal fixation.The 2 groups were compared in terms of indexes associated with surgery and hospitalization,Lysholm scores,EuroQol 5 dimensions （EQ-5D） indexes and visual analogue scale （VAS） at final follow-ups.Results All the patients were followed up for more than 2 years.The early operation group incurred significantly less operation time （229.1 ± 43.7 min）,intraoperative blood loss （297.5 ±51.5 mL）,hospital stay （11.9 ± 1.9 d） and expenditure [144,700 （103,200,179,900） Yuan RMB] than the delayed operation group [322.1 ±62.2 min,385.9 ±56.4 mL,21.5 ±3.6 d,and 197,700 （137,200,234,300） Yuan RMB,respectively] （P ＜ 0.05）.There were no significant differences between the 2 groups in rate of complications [22.2％ （4/18） versus 38.1％ （8/21）],fracture union time （6.1±1.1 mversus5.8±l.4m）,Lysholmscores （83.9±9.7 versus 81.1±12.3）,EQ-5Dindexes （0.85±0.09versus0.84±0.12）,orVAS （1.3±1.2versus 1.5±1.4） （P＞ 0.05）.Conclusions In the treatment of tibial plateau fractures combined with compartment syndrome,both primary decompressive internal fixation and delayed surgery can achieve satisfactory

关 键 词：胫骨骨折 创伤和损伤 骨折固定术 

分 类 号：R687.3[医药卫生—骨科学]