过伸与非过伸型胫骨平台骨折的比较

Comparison of hyperextension tibial plateau fractures with non-hyperextension counterparts

摘要:

[目的]探讨过伸型胫骨平台骨折手术方式选择及对预后的影响。[方法]回顾性分析 2016 年 1 月—2021 年 1 月本院采用开放复位内固定治疗 53 例胫骨平台骨折患者。参照 Firoozabadi 标准分为过伸型组 19 例，非过伸组 34 例。比较两组围手术期、随访及影像结果。[结果] 过伸组在合并伤的总发生率 （63.1% vs 23.4%, P＜0.05）、手术时间 [(141.3±19.7) min vs (107.6±15.4) min, P＜0.05]、切口长度 [(19.6±4.1) cm vs (15.4±3.4) cm, P＜0.05] 及术中失血量 [(228.3±33.9) ml vs (163.4±24.1) ml, P＜ 0.05] 显著大于非过伸组；两组术中透视次数、下地行走时间、切口愈合及住院时间的差异均无统计学意义（P＞0.05）。随访时间平均（14.3±1.1）个月，两组术后完全负重活动时间的差异无统计学意义（P＞0.05）。随时间推移，两组 KSS 临床评分、KSS 功能评分均显著增加（P＜0.05），术后 2 个月过伸型组 KSS 功能评分显著低于非过伸组 [(50.4±5.4) vs (54.7±5.8), P＜0.05]。影像方面，与术前相比，术后两组关节面对合度均显著改善（P＜0.05），MPTA 均显著增加（P＜0.05）。相应时间点，两组间关节面对合、骨折愈合时间、MPTA 的差异无统计学意义（P＞0.05）。术前过伸型组 PTS 显著小于非过伸组（P＜0.05），术后两组 PTS 的差异无统计学意义（P＞0.05）。[结论]与非过伸型骨折相比，过伸型胫骨平台骨折常合并其他结构损伤，手术治疗复杂，预后较差。

Abstract:

[Objective] To explore the choice of surgical methods and the influence on prognosis of hyperextension tibial plateau frac- tures. [Methods] A retrospective study was done on 53 patients who received open reduction and internal fixation (ORIF) for tibial plateau fractures in our hospital from January 2016 to January 2021. According to Firoozabadi's criteria, 19 patients fall in hyperextension (HE) group, while other 34 patients were in the non-hyperextension (NHE) group. The documents regarding to perioperative period, follow-up and imaging were compared between the two groups. [Results] The HE group proved significantly greater than the NHE group in terms of overall incidence of combined injury (63.1% vs 23.4%, P＜0.05), operation time [(141.3±19.7) min vs (107.6±15.4) min, P＜0.05], incision length [(19.6±4.1) cm vs (15.4±3.4) cm, P＜0.05] and intraoperative blood loss [(228.3±33.9) ml vs (163.4±24.1) ml, P＜0.05], despite of in- significant differences in intraoperative fluoroscopy times, ambulation time, incision healing grade and hospital stay between the two groups (P＞0.05). The mean follow-up time was of (14.3±1.1) months, and there was no significant difference in time to resume full weight-bearing activity between the two groups (P＞0.05). Both KSS clinical score and KSS functional score were significantly increased in both groups over time (P＜0.05), of which the KSS functional score in HE group was significantly lower than that of NHE group 2 months after surgery [(50.4± 5.4) vs (54.7±5.8), P＜0.05]. Radiographically, the joint congruity significantly improved (P＜0.05), while MPTA significantly increased post- operatively compared with those preoperatively (P＜0.05). However, there were no significant differences in joint congruity, fracture healing time and MPTA between the two groups any time points accordingly (P＞0.05). The PTS in HE group were significantly smaller than that in the NHE group preoperatively (P＜0.05), while became not statistically significant between the two groups postoperatively (P＞0.05). [Con- clusion] Hyperextension tibial plateau fracture is often associated with other structural injuries, and the surgical treatment is much more complicated with poor prognosis compared with the non-hyperextension counterpart.