两种牵引开放复位内固定胫骨平台三柱骨折△

Comparison of two tractions in open reduction and internal fixation for three-column tibial plateau fractures

摘要:

［目的］比较两种牵引下开放复位内固定胫骨平台三柱骨折的临床疗效。［方法］2018 年 5 月— 2021 年 1 月开放复位双钢板内固定治疗胫骨平台三柱骨折 30 例。按术前医患沟通结果，15 例采用新型牵引器牵引，15 例采用传统徒手牵引。比较两组围手术期、随访和影像资料。［结果］所有患者均顺利完成手术，无严重并发症。新型组手术时间、骨折复位时间、切口总长度、术中失血量均显著少于传统组 （P<0.05）。所有患者均获随访 （16.03±3.17） 个月。随时间推移，两组 VAS 评分显著减少（P<0.05），而膝伸屈 ROM、HSS 评分、Rasmussen 临床评分均显著增加（P<0.05）。术后 1 周和 1 个月，新型组的膝伸屈 ROM、HSS 评分、Rasmussen 临床评分均显著优于传统组 （P<0.05），但末次随访时，两组间上述指标的差异均已无统计学意义 （P>0.05）。两组完全负重时间的差异无统计学意义 （P>0.05）。影像方面，两组骨折临床愈合时间的差异无统计学意义 （P>0.05）。相应时间点，两组间 Rasmussen 解剖评分、胫骨近端内侧角、胫骨平台后倾角的差异均无统计学意义 （P>0.05）。 ［结论］此新型下肢骨折牵引装置安全、有效，可应用于仰卧、侧卧、俯卧等体位，可以提高手术效率，加快术后功能康复

Abstract:

[Objective] To compare the clinical efficacy of two tractions in open reduction and internal fixation (ORIF) of three-column tibial plateau fractures. [Methods] From May 2018 to January 2021, 30 patients received ORIF with double plates for three-column tibial plateau fractures. According to the results of doctor-patient communication before surgery, 15 had ORIF performed under a novel self-de- veloped traction device (NTD) , while the other 15 patients were under conventional manual traction. The perioperative, follow-up and imag- ing data were compared between the two groups. [Results] All patients were successfully operated on without serious complications. The NTD group proved significantly superior to the conventional group in terms of operation time, fracture reduction time, total incision length and intraoperative blood loss (P＜0.05) . As time went during follow up lasted for (16.03±3.17) months, the VAS scores decreased significant- ly (P＜0.05) , while knee extension-flexion range of motion (ROM) , HSS score and Rasmussen clinical score increased significantly in both groups (P＜0.05) . At 1 week and 1 month postoperatively, the NTD group was significantly superior to the conventional group in abovesaid items (P＜0.05) , whereas which became not statistically significant between the two groups at the latest follow-up (P＞0.05) . There was no significant difference in the time to resume full weight-bearing activity between the two groups (P＞0.05) . Radiographically, there was no a significant difference in fracture healing time between the two groups (P＞0.05) , additionally, no significant differences were noted in Ras- mussen anatomical score, medial proximal tibial angle (MPTA) and posterior tibial slope (PTS) between the two groups at any corresponding time points (P＞0.05) . [Conclusion] This novel self-developed traction device is safely and effectively used in ORIF for three-column tibi- al plateau fractures, with advantages of using in supine, lateral and prone position, improving the operation efficiency and speeding up the postoperative functional recovery.