不同方法治疗复杂开放性胫骨平台骨折的效果对比
| 作者: |
1付涛
1 鄂州市鄂钢医院骨科，湖北 鄂州 436000 |
| 通讯: |
付涛
Email: futaoxt@126.com |
| DOI: | 10.3978/j.issn.2095-6959.2016.03.005 |
摘要
目的：探讨复杂开放性胫骨平台骨折患者采用钢板内固定与外固定支架方式固定的临床疗效差异。方法：本研究采用回顾性研究方法对本院骨科2011年1月至2013年12月收治的57例胫骨平台开放性骨折患者的手术资料和随访资料进行分析，比较27例采用钢板内固定(内固定组)患者及30例采用外固定支架固定(外固定组)患者的临床疗效差异。结果：外固定组患者的手术时间为108.7±16.4 min、术中出血量65.8±21.7 mL、住院时间17.3±4.9 d均显著的短于内固定组患者(P<0.05)；内固定组患者的功能锻炼开始时间1.8±0.9月、术后负重时间3.8±0.6月、骨折愈合时间3.6±0.8月，均显著的短于外固定组患者(P<0.05)。内固定组和外固定组术后3 d、3、6个月时分别测量TPA、PA角，两组患者间比较差异均不具有统计学意义(P>0.05)。术后第3、6个月、末次随访内固定组患者的膝关节功能Lysholm评分[(82.41±2.88)、(85.92±3.27)、(88.84±3.75)]分均显著的高于同期外固定组患者的[(80.17±2.74)、(83.86±2.98)、(86.44±3.85)]分且差异具有统计学意义(P<0.05)。末次随访内固定组患者的膝关节功能为优级率70.37%高于外固定组的43.33%，良和差的构成比均低于外固定组，内固定组在末次随访时膝关节功能分布优于外固定组(P<0.05)。结论：复杂开放性胫骨平台骨折患者采用外固定支架手术可以减轻对患者的创伤，缩短手术时间，但是不利于骨折复位及早期患者对膝关节进行功能锻炼，这可能是造成术后外固定组患者膝关节功能较内固定差的原因。
关键词：
复杂开放性胫骨平台骨折
钢板内固定
外固定支架方式固定
临床疗效
Comparison of effect in different methods of treating complex open tibial plateau fractures
CorrespondingAuthor: FU Tao Email: futaoxt@126.com
DOI: 10.3978/j.issn.2095-6959.2016.03.005
Abstract
Objective: To investigate the clinical effects of plate internal fixation and external fixation in the treatment of complex open tibial plateau fractures. Methods: In this study, retrospective study was done in 57 cases of patients with open tibial plateau fractures that were treated in our hospital from January 2011 to December 2013. Surgery information and follow-up data were analyzed, and differences in efficacy between 27 cases of patients used the inner plate (internal fixation group) and 30 cases with external fixator (external fixation group) were compared. Results: Operative time of external fixation group was 108.7±16.4 min, blood loss was 65.8±21.7 mL, hospitalization time was 17.3±4.9 d, which was significantly shorter in patients with internal fixation group (P<0.05); functional exercise starting time in internal fixed group was 1.8±0.9 months, postoperative weight-bearing time was 3.8±0.6 months, fracture healing time was 3.6±0.8 months which were significantly shorter than the external fixation group of patients (P<0.05). TPA, PA angle were measured in internal fixation and external fixation group after 3 d, 3 months and 6 months, difference between the two groups were not statistically significant (P>0.05). Knee function within the last follow-up were measured by Lysholm score, fixation group [(82.41±2.88), (85.92±3.27), (88.84±3.75)] scores were significantly higher than the external fixation group in the same period [(80.17±2.74), (83.86±2.98), (86.44±3.85)] and the difference was statistically significant (P<0.05). Knee function fixed set of superior grade rate in the last follow-up was 70.37%, 43.33%, which was higher than the external fixation group; at the time of last follow-up, distribution knee function of the internal fixation group was higher than that of external fixation group (P<0.05). Conclusion: Complex open tibial plateau fractures treated with external fixation surgery can reduce the patient trauma, shorten the operation time, but it isn’t conducive to fractures and knee patients with early functional exercise, this may be the reason why postoperative knee function in external fixation group was not as good as internal fixation group.