两种手术入路治疗过伸型胫骨平台骨折的疗效比较  

Efficacy Comparison of Two Surgical Approaches in the Treatment of Hyperextension Tibial Plateau Fracture

作　　者：王利兵 尚晋 杨慧峰[1] 郭秀珍[1] 王东东 祁正玺 乔晓红[1] Wang Libing;Shang Jin;Yang Huifeng;Guo Xiuzhen;Wang Dongdong;Qi Zhengxi;Qiao Xiaohong(Lvliang People’s Hospital,Lvliang 033000,China;Shanxi Medical University,Taiyuan 030000,China;Xingxian People’s Hospital,Lvliang 033000,China)

机构地区：[1]吕梁市人民医院骨科,山西吕梁033000 [2]山西医科大学,山西太原030000 [3]兴县人民医院,山西吕梁033000

出　　处：《实用骨科杂志》2023年第11期985-988,1000,共5页Journal of Practical Orthopaedics

基　　金：吕梁市重点研发计划项目(2022SHFZ02)。

摘　　要：目的 对比前内侧联合前外侧入路与后内侧联合前外侧入路治疗过伸型胫骨平台骨折的临床疗效。方法 回顾性分析2018年4月至2022年4月吕梁市人民医院骨科采用前内侧或后内侧联合前外侧入路治疗的过伸型胫骨平台骨折患者资料72例,根据治疗方法分为A组和B组两组。A组(前内侧联合前外侧入路)35例,男25例,女10例;年龄20~73岁,平均(46.31±14.56)岁;B组(后内侧联合前外侧入路)37例,男26例,女11例;年龄23~73岁,平均(45.30±14.51)岁。比较两组患者手术时间、术中出血量、负重活动时间、视觉模拟评分(visual analogue scale,VAS)及术后并发症发生率评定两组的临床疗效,使用美国特种外科医院(hospital for special surgery,HSS)膝关节评分标准评定膝关节功能;根据X线片评定胫骨平台后倾角及内翻角的改变。结果 72例患者均获得随访,随访时间12~28个月,平均(17.93±4.13)个月。术后骨折均临床愈合,膝关节功能基本恢复正常。术后6个月时两组间的膝关节HSS评分差异无统计学意义(P>0.05),但术后12个月时A组膝关节HSS评分低于B组,差异有统计学意义(P<0.05),而且A组膝关节功能优良率明显低于B组,差异有统计学意义(P<0.05)。A组手术时间、术中出血量、术后1 d和3 d VAS评分及术后半年胫骨平台后倾角高于B组;B组负重活动时间及术后当天内翻角高于A组,差异有统计学意义(P<0.05)。结论 采用后内侧联合前外侧入路的手术方法治疗过伸型胫骨平台骨折短期随访治疗效果更佳,由于病例数较少且缺乏远期随访结果,还需要更进一步观察研究。Objective To compare the clinical efficacy of anteromedial combined anterolateral approach and posteromedial combined anterolateral approach in the treatment of hyperextension tibial plateau fracture.Methods Data of 72 patients with hyperextension tibial plateau fracture treated with anteromedial or posteromedial combined anterolateral approach in the Department of Orthopedics of Luliang People's Hospital from April 2018 to April 2022 were retrospectively analyzed,and they were divided into group A and group B according to treatment methods.Patients of Group A underwent anteromedial combined anterolateral approach surgeries.Group A had 35 patients,including 25 males and 10 females.The patients aged 20~73 years,with an average age of(46.31±14.56) years.Patients of Group B underwent posteromedial combined anterolateral approach surgeries.Group B had 37 patients,including 26 males and 11 females.The patients aged 23~73 years,with an average age of(45.30±14.51) years.Operation time,intraoperative blood loss,weight-bearing activity time,visual analogue scale(visualanaloguescale,VAS) and postoperative complication rates were compared to assess the clinical efficacy of two groups.American hospital for special surgery(hospitalforspecialsurgery,HSS) Knee joint scoring criteria were used to assess knee joint function.The changes of posterior inclination and varus Angle of tibial plateau were evaluated by X-ray.Results All 72 patients were followed up for 12~28 months,with an average of(17.93±4.13) months.All fractures healed clinically and the function of knee joint returned to normal.There was no statistically significant difference in knee HSS score between the two groups at 6 months after surgery(P>0.05),but the knee HSS score of group A was lower than that of group B at 12 months after surgery,the difference was statistically significant(P<0.05),and the excellent and good knee function rate of group A was significantly lower than that of group B,the difference was statistically significant(P<0.05).The operative time

关 键 词：膝关节 过伸型 胫骨平台骨折 双切口入路 

分 类 号：R683.42[医药卫生—骨科学]