以基础骨块为标准逐步叠加复位法辅助切开复位内固定术治疗创伤性复杂胫骨平台骨折的效果观察  

Observations of the Effects of Stepwise Superposition Reduction Method Using the Base Bone Fragments as a Standard Assisted with Open Reduction and Internal Fixation on the Treatment of Traumatic Complex Tibial Plateau Fractures

作　　者：周金军 邓琳[2] 翁德雨 王梅生 谭力 陈建军 ZHOU Jinjun;DENG Lin;WENG Deyu;WANG Meisheng;TAN Li;CHEN Jianjun(Department of Trauma,Pukou People's Hospital,Nanjing 211800,China;Department of Rheumatology and Immunology,Dongtai People's Hospital,Dongtai,Jiangsu 224200,China)

机构地区：[1]南京市浦口人民医院创伤科,南京211800 [2]东台市人民医院风湿免疫科,江苏东台224200

出　　处：《临床误诊误治》2025年第6期60-67,共8页Clinical Misdiagnosis & Mistherapy

基　　金：2020年度南京市卫生科技发展专项资金项目(YKK20250);江苏省卫生健康发展研究中心2021年度开放课题(JSHD2021061)。

摘　　要：目的探讨以基础骨块为标准逐步叠加复位法辅助切开复位内固定术治疗创伤性复杂胫骨平台骨折的效果及对关节功能的影响。方法选取2019年1月至2024年1月收治创伤性复杂胫骨平台骨折患者102例,按随机数字表法分为改良组和常规组各51例。常规组行常规切开复位内固定术,改良组行以基础骨块为标准逐步叠加复位法辅助切开复位内固定术。比较2组手术指标、骨折复位质量[Rasmussen放射学评分中胫骨髁部骨折复位解剖学评分]、手术前后下肢力线[膝关节间隙宽度、胫骨平台塌陷、外侧后倾角(PA)、内翻角(TPA)、股胫角(FTA)]、膝关节功能(HSS)评分、疼痛程度[视觉模拟评分法(VAS)]、术后膝关节活动度及并发症发生率。结果改良组手术时间、术后首次下床时间、住院时间、骨折愈合时间短于常规组(P<0.01)。改良组骨折复位质量优于常规组(P<0.05)。改良组术后3 d、术后6个月膝关节间隙宽度、胫骨平台塌陷、PA、TPA低于常规组(P<0.01);2组术后3 d、术后6个月FTA比较差异无统计学意义(P>0.05);术后3、6个月改良组HSS评分高于常规组,VAS评分低于常规组(P<0.05);术后1周、3个月、6个月改良组伸膝最大角度、屈膝最大角度高于常规组(P<0.05);改良组并发症总发生率低于常规组(P<0.05)。结论创伤性复杂胫骨平台骨折采用以基础骨块为标准逐步叠加复位法辅助切开复位内固定治疗可提高复位质量,有效缓解术后疼痛,改善下肢力线及膝关节功能。Objective To investigate the effect of stepwise superposition reduction based on the basic bone fragments in the treatment of traumatic complex tibial plateau fractures with open reduction and internal fixation(ORIF)and its impact on joint function.Methods A total of 102 patients with traumatic complex tibial plateau fractures admitted from January 2019 to January 2024 were selected and divided into modified group(n=51)and conventional group according to the random number table method(n=51).The conventional group underwent conventional ORIF,and the modified group underwent ORIF assisted by stepwise superposition reduction based on the basic bone fragments.The surgical indicators,fracture reduction quality[anatomical score of tibial condyle fracture reduction in Rasmussen radiological score],lower limb alignment[knee joint space width,tibial plateau collapse,lateral posterior angle(PA),tibial plateau angle(TPA),femorotibial angle(FTA)],knee joint function hospital for special surgery(HSS)score,and pain degree[visual analogue scale(VAS)],postoperative range of motion of knee joint and incidence of complications were compared between the two groups.Results The duration of operation,time to first ambulation,length of hospitalization and fracture healing time of the modified group were shorter than those of the conventional group(P<0.01).The quality of fracture reduction in the modified group was better than that in the conventional group(P<0.05).The knee joint space width,tibial plateau collapse,PA,and TPA in the modified group were lower than those in the conventional group at 3 d and 6 months after operation(P<0.01).There was no significant difference in FTA between the two groups at 3 d and 6 months after operation(P>0.05).At 3 and 6 months after operation,the HSS scores in modified group were higher than those in conventional group,and the VAS scores were lower than those in conventional group(P<0.05).The maximum angle of knee extension and flexion in the modified group were higher than those in the conventional

关 键 词：胫骨平台骨折 逐步叠加复位 切开复位内固定 胫骨平台塌陷 外侧后倾角 股胫角 膝关节功能 手术后并发症 

分 类 号：R683.42[医药卫生—骨科学]