新复位方法在手术治疗复杂胫骨平台骨折中的应用  

Novel reduction technique in surgical treatment of complex tibial plateau fractures

作　　者：张聪明[1] 段宁[1] 王谦[1] 马腾[1] 薛汉中[1] 刘宏亮 张诚诚 张堃[1] 李忠[1] Zhang Congming;Duan Ning;Wang Qian;Ma Teng;Xue Hanzhong;Liu Hongliang;Zhang Chengcheng;Zhang Kun;Li Zhong(Department of Orthopaedics and Traumatology,Hong Hui Hospital,Xi'an Jiaotong University College of Medicine,Xi'an 710054,China)

机构地区：[1]西安交通大学附属红会医院创伤骨科医院下肢病区,710054

出　　处：《中华创伤骨科杂志》2020年第10期908-911,共4页Chinese Journal of Orthopaedic Trauma

基　　金：西安市卫生与计划委员会(J201703056);西安市科技计划(2019114613YX001SF038)。

摘　　要：目的探讨新复位方法在治疗复杂胫骨平台骨折患者术中应用的效果。方法回顾性分析2016年5月至2018年9月西安交通大学附属红会医院创伤骨科医院下肢病区手术治疗的50例SchatzkerⅤ、Ⅵ型胫骨平台骨折患者资料。男34例,女16例;年龄27~56岁,平均42.3岁。将患者按照术中复位方法不同分为两组,新复位方法组(n=23):按照由远及近的原则,以骨折远端为基础骨块,其他骨块以基础骨块为标准,逐一复位,最后复位压缩的骨折并固定;传统复位方法组(n=27):先复位关节面再将关节面骨块与胫骨骨折远端固定。比较两组患者术中出血量及手术时间。术后第2天摄膝关节正位X线片,测量胫骨平台内翻角(TPA)。根据TPA在±5°内被认为可接受,超过±5°被认为不可接受,比较两组患者的TPA可接受率。结果两组患者术前一般资料比较差异均无统计学意义(P>0.05),具有可比性。两组患者的手术时间[(2.7±0.4)、(3.0±0.6)h]和术中出血量[(215±56)、(221±52)mL]比较差异均无统计学意义(P>0.05)。新复位方法组患者的TPA可接受率为78.2%(18/23)高于传统复位方法组的48.1%(13/27),差异有统计学意义(P<0.05)。结论与传统复位方法相比,新复位方法在手术治疗复杂胫骨平台骨折时可以提高术中胫骨平台骨折复位的可接受率,但并不增加患者的手术时间和术中出血量,为复杂胫骨平台骨折的切开复位内固定提供新的治疗思路。Objective To explore the efficacy of our novel reduction technique in the surgical treatment of complicated tibial plateau fractures.Methods From May 2016 to September 2018,50 fractures of tibial plateau(Schatzker typesⅤandⅥ)were treated at Department of Orthopaedics and Traumatology,Hong Hui Hospital.They were 34 males and 16 females,aged from 27 to 56 years(average,42.3 years).They were divided into 2 groups according to the reduction techniques.In the group of novel reduction(n=23),bone fragments were reduced one by one from the distal to the proximal until the compression fracture was reduced and fixated.In the conventional reduction group(n=27),the articular surface was reduced first before fixation of articular fragments with distal ends of tibial fracture.The 2 groups were compared in terms of intraoperative bleeding,operation time,tibial plateau angle(TPA)on the knee anteroposterior X-ray film taken on the second day after operation,and rate of acceptable TPA(±5°).Results There were no significant differences between the 2 groups in general preoperative data,showing comparability(P>0.05).There were no significant differences between the 2 groups in either operation time(2.7 h±0.4 h versus 3.0 h±0.6 h)or intraoperative bleeding(215 mL±56 mL versus 221 mL±52 mL)(P>0.05).The novel reduction group had a significantly higher rate of acceptable TPA[78.2%(18/23)]than the conventional reduction group[48.1%(13/27)](P<0.05).Conclusion In the surgical treatment of complicated tibial plateau fractures,compared with conventional reduction technique,our novel reduction technique can increase the rate of acceptable reduction but not operation time nor intraoperative bleeding.

关 键 词：胫骨 骨折 外科手术 复位顺序 

分 类 号：R687.3[医药卫生—骨科学]