复杂胫骨平台骨折手术时机与手术方式的选择及疗效评价(1)
[摘要]目的 探討复杂胫骨平台骨折手术中手术时机和手术方式的选择对手术疗效的影响。方法 选择2015年1月～2017年6月我院收治的69例复杂胫骨平台骨折患者作为研究对象，采用随机数字表法分为A、B、C三组，每组各23例。A组患者采用膝前外侧单切口单钢板内固定术治疗，B组患者采用膝前正中切口双钢板内固定术治疗，C组患者采用膝前后联合入路双钢板内固定术治疗，比较三组患者不同手术方式的骨折愈合时间，内固定失败率，术中出血量及三组患者不同手术时机并发症总发生率。结果 C组患者的骨折愈合时间短于A组和B组，内固定失败率低于A组和B组，术中出血量多于A组和B组，差异均有统计学意义(P<0.05)；B组患者的骨折愈合时间短于A组，内固定失败率低于A组，术中出血量多于A组，差异均有统计学意义(P<0.05)；手术时机选择6～8 d患者的术后并发症总发生率显著低于其他时机，差异有统计学意义(P<0.05)。结论 复杂胫骨平台骨折手术方式采用膝前后联合入路双钢板内固定术为主，根据患者的情况灵活选择内固定方法。在患者骨折后6～8 d进行手术，可降低术后并发症的发生。
[关键词]复杂胫骨平台骨折；手术时机；手术方式；疗效
[中图分类号] R683 [文献标识码] A [文章编号] 1674-4721(2018)12(c)-0099-03
[Abstract] Objective To explore the effect of surgical timing and method for the surgical outcome of complex tibial plateau fractures. Methods Sixty-nine patients with complex tibial plateau fractures admitted to our hospital from January 2015 to June 2017 were selected as the study subjects， they were divided into group A， B and C by random number table method， with 23 cases in each group. Group A was treated with anterolateral single incision single plate internal fixation， group B was treated with anterolateral median incision double plate internal fixation， and group C was treated with anterolateral combined approach double plate internal fixation， the fracture healing time， failure rate of internal fixation， intraoperative bleeding volume and the total incidence of complications in three groups were compared. Results The fracture healing time of group C was shorter than that of group A and group B， the failure rate of internal fixation was lower than that of group A and group B， and the amount of bleeding during operation was more than that of group A and group B， the differences were statistically significant (P<0.05). The healing time of fracture in group B was shorter than that in group A， the failure rate of internal fixation was lower than that in group A， and the amount of bleeding during operation was more than that in group A， the differences were statistically significant (P<0.05). The total incidence of postoperative complications was significantly lower in patients with 6-8 days of operation timing than in patients with other timing， and the differences were statistically significant (P<0.05). Conclusion Complex tibial plateau fractures are mainly treated with anterior and posterior knee joint approach and double plate internal fixation， the method of internal fixation should be flexibly selected according to the patient′s condition. Surgery 6 to 8 days after fracture can reduce the incidence of postoperative complications., http://www.100md.com(简蔚泓 廖学勤 叶栋)
[关键词]复杂胫骨平台骨折；手术时机；手术方式；疗效
[中图分类号] R683 [文献标识码] A [文章编号] 1674-4721(2018)12(c)-0099-03
[Abstract] Objective To explore the effect of surgical timing and method for the surgical outcome of complex tibial plateau fractures. Methods Sixty-nine patients with complex tibial plateau fractures admitted to our hospital from January 2015 to June 2017 were selected as the study subjects， they were divided into group A， B and C by random number table method， with 23 cases in each group. Group A was treated with anterolateral single incision single plate internal fixation， group B was treated with anterolateral median incision double plate internal fixation， and group C was treated with anterolateral combined approach double plate internal fixation， the fracture healing time， failure rate of internal fixation， intraoperative bleeding volume and the total incidence of complications in three groups were compared. Results The fracture healing time of group C was shorter than that of group A and group B， the failure rate of internal fixation was lower than that of group A and group B， and the amount of bleeding during operation was more than that of group A and group B， the differences were statistically significant (P<0.05). The healing time of fracture in group B was shorter than that in group A， the failure rate of internal fixation was lower than that in group A， and the amount of bleeding during operation was more than that in group A， the differences were statistically significant (P<0.05). The total incidence of postoperative complications was significantly lower in patients with 6-8 days of operation timing than in patients with other timing， and the differences were statistically significant (P<0.05). Conclusion Complex tibial plateau fractures are mainly treated with anterior and posterior knee joint approach and double plate internal fixation， the method of internal fixation should be flexibly selected according to the patient′s condition. Surgery 6 to 8 days after fracture can reduce the incidence of postoperative complications., http://www.100md.com(简蔚泓 廖学勤 叶栋)