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    改良后内侧联合腓骨小头上入路手术对Schatzker Ⅴ、Ⅵ型胫骨平台骨折的临床疗效分析

    Clinical efficacy analysis of improved medial combined with supracapular approach for Schatzker type Ⅴ and Ⅵ tibial plateau fractures

      摘要
    • 摘要:
      目的 比较采用改良后内侧联合腓骨小头上入路和常规前外及后内侧入路置入外侧“L”型、内侧“T”型钢板及后侧阻挡钢板治疗Ⅴ型及以上复杂胫骨平台骨折的临床疗效。
      方法 回顾性研究伴后内及后外侧平台塌陷的复杂胫骨平台骨折病人58例。改良组术中取病人平卧“4字”体位，采用改良后内侧联合腓骨小头上入路，常规组采取漂浮体位并使用前外及后内入路分别行手术治疗。如术中骨缺损较多予以自体骨植骨，记录手术时间、透视次数，出血量、并发症及Rasmussen影像学评分、美国特种外科医院评分、膝关节活动度、胫骨平台角及内侧后倾角。
      结果 病人均获12个月随访。改良组切口长度、骨折显露时间、手术时间、术中出血量均少于常规组(P < 0.01)。改良组术后1、3个月美国纽约特种外科医院评分、Rasmussen评分均高于常规组(P < 0.01)。改良组术后1、3、12个月视觉模拟评分均低于常规组(P < 0.01)。改良组术后1、3、12个月欧洲五维健康量表指数均高于常规组(P < 0.05~P < 0.01)。2组其余指标比较差异均无统计学意义(P>0.05)。
      结论 相比于传统入路，SchatzkerⅤ、Ⅵ型胫骨平台骨折手术病人采用改良后内侧联合腓骨小头上入路，可有效提高术中骨折部位固定效果，有利于术后膝功能修复。

       

      Abstract:
      Objective To compare the clinical efficacy of using an improved medial combined with supracapular approach and conventional anterior and posterior medial approaches to place lateral "L" - shaped, medial "T" - shaped plates, and posterior blocking plates for the treatment of complex tibial plateau fractures of type Ⅴ and above.
      Methods A retrospective study was conducted on 58 patients with complex tibial plateau fractures accompanied by posterior medial and posterior lateral platform collapse.In the improved group, the patient was placed in a supine "four figure" position during surgery, and an improved medial combined with supracapular was used.In the control group, a floating position was adopted and surgery was performed using anterior lateral and posterior internal approaches, respectively.If there were many bone defects during the operation, autologous bone grafting was performed.The surgical time, number of fluoroscopies, bleeding volume, complications, Rasmussen imaging score, HSS score, knee joint range of motion, tibial plateau angle, and medial posterior inclination angle were recorded.
      Results All patients were followed up for 12 months.The incision length, fracture exposure time, surgical time, and intraoperative bleeding in the improved group were lower than those in the conventional group (P < 0.01).The HSS and Rasmussen scores of the improved group were higher than those of the conventional group at 1, 3 months after surgery (P < 0.01).The visual simulation scores of the improved group were lower than those of the conventional group at 1, 3, and 12 months after surgery (P < 0.01).The European five dimensional health scale index of the improved group was higher than that of the conventional group at 1, 3, and 12 months after surgery (P < 0.05 to P < 0.01).There was no statistically significant difference in other indicators between the two groups (P>0.05).
      Conclusions Compared to conventional approaches, patients undergoing Schatzker type Ⅴ and Ⅵ tibial plateau fractures can effectively improve the fixation effect of the fracture site during surgery by using the improved medial combined with supracapular approach, which is beneficial for postoperative knee function repair.

       

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