Comparison between two approaches in treatment of patients with complex tibial plateau fractures
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摘要:目的 探讨两种入路方式治疗复杂胫骨平台骨折的疗效及对胫骨平台内翻角、后倾角的影响。方法 选取复杂胫骨平台骨折患者109例，内外侧入路治疗79例为观察组，后侧入路30例为对照组。测量术后即时、6个月、1年时的胫骨平台内翻角、后倾角以及膝关节活动度，采用Rasmussen评分评估疗效，观察术后并发症。结果 术后即时，观察组内翻角、后倾角大于对照组，差异有统计学意义(P < 0.05); 术后6个月、术后1年，2组内翻角、后倾角以及术后1年膝关节活动度比较，差异无统计学意义(P>0.05)。观察组优良率为88.61%, 高于对照组的80.00%, 差异有统计学意义(P < 0.05)。观察组手术时间长于对照组，出血量大于对照组，骨折愈合时间短于对照组，差异有统计学意义(P < 0.05)。2组均无严重并发症发生。结论 内外侧入路治疗复杂胫骨平台骨折疗效显著，可显著改善胫骨平台内翻角、后倾角。Abstract:Objective To explore the efficacy of two approaches in treating complex tibial plateau fractures and their influence on varus angle and caster angle of tibial plateau.Methods A total of 109 patients with complex tibial plateau fractures were selected and divided into observation group (79 cases with treatment of internal and external approach) and control group (30 cases with treatment of posterior approach). Varus angle, caster angle of tibial plateau and motion of knee joint were measured immediately, 6 months and 1 year after operation, the therapeutic effect was assessed by Rasmussen score, and the postoperative complications were observed.Results The varus angle and caster angle immediately after operation in the observation group were significantly larger than those in the control group (P < 0.05). There were no significant differences in varus angles and caster angles 6 months and 1 year after operation and motion of knee joint 1 year after operation between the two groups (P>0.05). The excellent and good rate of the observation group was 88.61%, which was significantly higher than that 80.00% of the control group (P < 0.05). The operation time and the amount of bleeding in the observation group were significantly longer and larger than those in the control group, while the fracture healing time was significantly shorter than that in the control group (P < 0.05). No serious complications occurred in both groups.Conclusion The internal and external approaches are effective in the treatment of complex tibial plateau fractures, which can significantly improve the varus angle and caster angle of tibial plateau.
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表 1 2组术后内翻角、后倾角以及膝关节活动度比较(x±s)
° 指标 对照组(n=30) 观察组(n=79) 内翻角 术后即时 83.12±1.50 84.03±1.62* 术后6个月 85.09±1.48 85.12±1.45 术后1年 85.47±1.56 85.59±1.59 后倾角 术后即时 7.48±1.51 7.60±1.53* 术后6个月 7.89±1.17 7.93±1.21 术后1年 7.99±1.88 8.05±2.02 膝关节活动度 116.49±10.57 118.35±12.28 与对照组比较, *P < 0.05。 
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表 2 2组膝关节功能比较[n(%)]
功能状况 对照组(n=30) 观察组(n=79) 优 10(33.33) 30(37.97) 良 14(46.67) 40(50.63) 可 4(13.33) 6(7.59) 差 2(6.67) 3(3.78) 优良 24(80.00) 70(88.61)* 与对照组比较, *P < 0.05。
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表 3 2组手术指标比较(x±s)
指标 对照组(n=30) 观察组(n=79) 手术时间/min 65.30±7.29 86.54±5.61* 术中出血量/mL 219.52±58.49 284.31±62.89* 骨折愈合时间/d 152.01±35.29 107.56±26.11* 与对照组比较, *P < 0.05。
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