老年过伸型胫骨平台骨折双钢板与三钢板固定△

Double plates versus triple plates for internal fixation of hyperextension tibial plateau fracture in elderly

摘要:

[目的] 比较双钢板与三钢板内固定治疗老年过伸型胫骨平台骨折的临床疗效。[方法] 回顾性分析2017 年4 月—2022 年4 月本院收治的80 例老年过伸型胫骨平台骨折患者的临床资料。根据医患沟通结果，40 例采用双钢板内固定治疗（双板组），40 采用三钢板内固定治疗（三板组），比较两组围手术期、随访及影像资料。[结果] 所有患者均顺利完成手术，双板组在手术时间[(119.6±25.6) min vs (132.5±27.2) min, P=0.032]、术中失血量[(249.5±40.3) ml vs (273.3±47.9) ml, P=0.019] 均显著少于三板组，而双板组下地行走时间显著晚于三板组[(69.5±9.7) d vs (63.7±7.9) d, P=0.019]，术后1 d [(8.1±0.9) vs (8.5±0.7), P=0.013]、3 d [(4.8±1.1) vs (5.3±0.9), P=0.016] 双板组的VAS 评分显著优于三板组，术后12 d 时两组间VAS 评分的差异无统计学意义（P＞0.05）。随访时间平均（16.2±2.6） 个月。两组恢复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，两组患者膝痛VAS 评分、膝关节HSS 评分和膝伸屈ROM 均显著改善（P＜0.05）。术后6 个月，双板组在膝痛VAS 评分[(1.8±0.7) vs (1.5±0.5), P=0.025]、HSS 评分[(65.5±4.4) vs (67.7±4.5), P=0.026] 及膝伸屈ROM [(102.3±4.3)° vs (104.3±4.4)°, P=0.044] 均显著不及三板组，但术后12 个月两组间上述指标的差异均无统计学意义（P＞0.05）。影像方面，两组间骨折复位质量、骨折愈合时间、胫骨后倾角（posterior tibal slope, PTS） 和内侧胫骨近端角（medial proximal tibial angle, MPTA） 的差异均无统计学意义（P＞0.05）。[结论] 两种术式治疗老年过伸型胫骨平台骨折均可取得满意疗效，相比之下，双钢板内固定手术创伤更小，术后早期疼痛更轻。

Abstract:

[Objective] To compare the clinical efficacy of double-plate (DP) versus triple-plate (TP) internal fixation of hyperexten-sion tibial plateau fractures in the elderly. [Methods] A retrospective research was performed on 80 elderly patients who received open re-duction and internal fixation (ORIF) for hyperextension tibial plateau fractures in our hospital from April 2017 to April 2022. According todoctor-patient discussion before operation, 40 patients were treated by ORIF with DP, while other 40 patients were with TP. The periopera-tive, follow-up and imaging data of the two groups were compared. [Results] All patients in both groups had operation performed successful-ly. The DP cohort proved significantly less than the TP cohort in terms of operative time [(119.6±25.6) min vs (132.5±27.2) min, P=0.032]and intraoperative blood loss [(249.5±40.3) ml vs (273.3±47.9) ml, P=0.019], although the DP group resumed postoperative ambulation sig-nificantly later than the TP group [(69.5±9.7) days vs (63.7±7.9) days, P=0.019]. In addition, the DP group was marked significantly lessVAS than the TP group 1 day [(8.1±0.9) vs (8.5±0.7), P=0.013] and 3 days postoperatively [(4.8±1.1) vs (5.3±0.9), P=0.016], whereas whichbecame not significant between the two groups 12 days after surgery (P＞0.05). The average follow-up time lasted for (16.2±2.6) months, andthere was no significant difference in time to recover full weight-bearing activities between the two groups (P＞0.05). The knee pain VASscore, HSS score and knee extension-flexion ROM significantly improved over time in both groups (P＜0.05). The DP cohort was significant-ly inferior to the TP cohort in terms of VAS [(1.8±0.7) vs (1.5±0.5), P=0.025], HSS [(65.5±4.4) vs (67.7±4.5), P=0.026] and knee extensionflexionROM [(102.3±4.3)° vs (104.3±4.4)°, P=0.044] 6 months after surgery, while which turned to be not statistically significant betweenthe two groups 12 months postoperatively (P＞0.05). Regarding imaging, there were no significant differences in terms of reduction quality of the fractures and healing time, as well as posterior tibial slope (PTS), medial proximal tibial angle (MPTA) at matching time points between

the two groups (P>0.05). [Conclusion] ORIF with both DP and TP achieve satisfactory outcomes for hyperextension tibial plateau fractures

in the elderly. By contrast, the DP induces less iatrogenic trauma with less postoperative pain over the TP.