双反牵引闭合复位经皮内固定与切开复位内固定治疗胫骨平台骨折术后炎症指标和效果的比较  

Comparison of postoperative inflammatory markers and surgical outcomes between open reduction and internal fixation versus double reverse traction closed reduction and percutaneous internal fixation for tibial plateau fractures

作　　者：史泰龙 丁凯 宇文培之[1] 郑占乐[1] 吕红芝[1] 朱燕宾 张奇[1] 陈伟[1] 侯志勇[1,2] 张英泽 Shi Tailong;Ding Kai;Yuwen Peizhi;Zheng Zhanle;Lyu Hongzhi;Zhu Yanbin;Zhang Qi;Chen Wei;Hou Zhiyong;Zhang Yingze(Department of Orthopaedic Surgery,The Third Hospital of Hebei Medical University,Shijiazhuang 050051,China;Engineering Research Center of Orthopedic Minimally Invasive Intelligent Equipment,Ministry of Education,Key Laboratory of Biomechanics of Hebei Province,NHC Key Laboratory of Intelligent Orthopaedic Equipment,Shijiazhuang 050051,China)

机构地区：[1]河北医科大学第三医院骨外科,石家庄050051 [2]骨科微创智能装备教育部工程研究中心,河北省生物力学重点实验室,NHC智能骨科装备重点实验室,石家庄050051

出　　处：《中华创伤骨科杂志》2025年第2期125-132,共8页Chinese Journal of Orthopaedic Trauma

基　　金：国家自然科学青年基金(82102584)。

摘　　要：目的双反牵引闭合复位经皮内固定与比较切开复位内固定治疗胫骨平台骨折术后炎症指标和效果。方法回顾性分析2023年1月至2023年12月期间河北医科大学第三医院骨外科收治的胫骨平台骨折229例患者资料。男155例,女74例;年龄为(48.7±10.9)岁。根据手术方式不同将患者分为2组:常规组87例(采用切开复位内固定治疗)和微创组142例(采用双反牵引闭合复位经皮内固定治疗)。记录并比较两组患者的术前及术后第1天血液学指标[包括白细胞计数(WBC)、中性粒细胞计数(NEUT)、淋巴细胞计数(LYM)、单核细胞计数(Mono)、血小板计数(PLT)、白蛋白(ALB)]和复合炎症指标[包括中性粒细胞与淋巴细胞比率(NLR)、血小板与淋巴细胞比率(PLR)、系统免疫炎症指数(SII)、系统性炎症反应指数(SIRI)]、术中出血量、手术时间、骨折愈合时间、膝关节美国特种外科医院(HSS)评分及血栓形成发生率。结果两组患者之间基线特征和治疗变量比较差异均无统计学意义(P>0.05),具有可比性。所有患者术后获(16.5±2.8)个月随访。与各自组内术前比较,两组患者术后第1天LYM、ALB降低,WBC、NEUT、Mono、PLT、NLR、PLR、SII、SIRI均升高,差异均有统计学意义(P<0.05)。术前患者血液学指标和复合炎性指标两组间比较差异均无统计学意义(P>0.05)。术后第1天两组患者间WBC、NEUT、LYM、ALB和NLR比较差异均无统计学意义(P>0.05),微创组患者的Mono、PLT、PLR、SII、SIRI较常规组更低,差异均有统计学意义(P<0.05)。微创组患者术中出血量、手术时间、骨折愈合时间、HSS评分、血栓形成发生率均优于常规组,差异均有统计学意义(P<0.05)。结论相较于常规切开复位内固定,双反牵引闭合复位经皮内固定治疗胫骨平台骨折在降低炎症指标方面具有明显优势,且手术效果更好。ObjectiveTo compare postoperative inflammatory markers and surgical outcomes between open reduction and internal fixation versus double reverse traction closed reduction and percutaneous internal fixation for tibial plateau fractures.MethodsA retrospective analysis was conducted of the data of 229 patients with tibial plateau fracture who had been admitted to Department of Orthopaedic Surgery,The Third Hospital of Hebei Medical University from January 2023 to December 2023.There were 155 males and 74 females with an age of(48.7±10.9)years.According to the surgical methods,the patients were divided into 2 groups.A conventional group of 87 cases were treated by open reduction and internal fixation while a minimally invasive group of 142 cases treated with double reverse traction closed reduction and percutaneous internal fixation.The 2 groups were compared in terms of hematological indexes[white blood cell count(WBC),neutrophil count(NEUT),lymphocyte count(LYM),monocyte count(Mono),platelet count(PLT),and albumin(ALB)]and composite inflammatory indexes[neutrophil to lymphocyte ratio(NLR),platelet-to-lymphocyte ratio(PLR),systemic immune-inflammatory index(SII),systemic inflammatory response index(SIRI)]before operation and on the first day after operation,intraoperative blood loss,operation time,fracture healing time,Hospital for Special Surgery(HSS)knee score and incidence of thrombosis.ResultsThere were no significant differences in baseline characteristics or treatment variables between the 2 groups,indicating comparability(P>0.05).All the 229 patients were followed up for(16.5±2.8)months.In each group,comparisons between preoperation and postoperation showed that LYM and ALB significantly decreased while WBC,NEUT,Mono,PLT,NLR,PLR,SII and SIRI significantly increased on the first day after operation(P<0.05).Preoperatively,there were no significant differences between the 2 groups in terms of hematological or composite inflammatory indexes(P>0.05).On the first day after operation,there was no significant differ

关 键 词：胫骨骨折 骨折固定术 内 牵引术 外科手术 微创性 单核细胞 血小板 

分 类 号：R687.3[医药卫生—骨科学]