【作者】 孙超；

【导师】 刘光耀；

【作者基本信息】 吉林大学 ， 临床医学（专业学位）， 2017， 硕士

【摘要】 目的:研究联合入路下、三钢板与双钢板对于胫骨平台三柱骨折的治疗的临床疗效,进行对比分析,评价两种方法下对于胫骨平台三柱骨折的治疗效果。资料与方法:选取2014年8月1日—2016年1月31日期间,满足筛选条件的,我院骨科收治的胫骨平台三柱骨折患者。筛选条件为闭合性骨折、单膝、诊断明确(排除合并有其他心、肺、肝、肾、血液、免疫等内科疾病及精神障碍患者),共68例。其中采用联合入路三钢板治疗的有28例(A组),联合入路双钢板治疗的有40例(B组),分别采取的手术方法为前外侧联合后侧倒L入路三钢板固定与前外侧联合后内侧入路双钢板固定。术前均进行全面的实验室及影像学检查,相关科室会诊等术前处理,充分术前准备。统计对比两组的手术时间、出血量、平均住院日、术后并发症、骨折愈合时间、完全负重时间。测量术后即刻及术后12个月患膝内翻角(TPA)及后倾角(PSA)及术后12个月膝关节活动度,术后12个月HSS膝关节评分及SF-36评分,评价术后膝关节功能恢复情况。对以上数据使用统计学数据分析软件SPSS 22.0进行统计学分析,综合评估对比两组手术疗效。结果:两组患者均进行了全部随访,无一例随访缺失,随访月数范围为12~30个月,平均随访月数为16.9个月。手术时间A组(99.3±12.0)min,B组(91.8±10.0)min,P=0.006,差异具有统计学意义;术后12个月SF-36评分A组(81.0±6.2)分,B组(74.6±6.9)分,P=0.000(<0.05),差异有显著统计学意义;按HSS膝关节功能评分标准,A、B两组优良率分别为89.3%和76.5%,卡方检验结果:X2值4.345,P=0.037<0.05,两组膝关节功能优良率差异有统计学意义。术后12月膝关节活动度,A组2~122°略大于B组2~119°B组。术后即刻与术后12月患膝胫骨平台后倾角分别(10.35±2.31)°、(11.13±2.43)°,t=-4.466,P=0.000,差异有显著统计学意义。结论:对于复杂的胫骨平台骨折,尤其是三柱骨折,采取联合入路三钢板对其每一柱的骨折的坚强固定,比联合入路双钢板治疗的三柱骨折,可以更好地解剖复位并坚强固定骨折块,能够更有效地进行术后康复功能锻炼。其并发症并未增加,而其疗效更加确切。后柱复杂骨折的固定,采取后侧倒L入路具有更好的优越性。更多还原

【Abstract】 PURPOSE:To study the clinical efficacy of treble plate and double plate for the treatment of tibial plateau fracture of three columns,and evaluate the therapeutic effect of the two methods for the treatment of tibial plateau fracture of three columns.METHODS:Choose the patiens with tibial plateau fracture of three columns from August 1,2014 to January 31,2016,whose meet the screening criteria.All the patients were treated in our department of orthopedics.The screening condition was closed fracture,one knee,the diagnosis was clear(excluding the other heart,lung,liver,kidney,blood,immune and other medical diseases and mental disorders),a total of 68 cases.There were 28 cases(group A)treated with the combined approach of treble plate,and 40 cases(group B)were treated by combined approach of double plate.The group A were treated with the approach of anterolateral and posterior reversed L that with the fixation of treble plate,while the group B were the approach of anterolateral Posteromedial.Before the operation,all the laboratory and imaging examinations were carried out,and the preoperative consultation and consultation were carried out to make sufficient preoperative preparation.The operation time,blood loss,average length of stay,postoperative complications,fracture healing time,and full weight-bearing time were compared between the two groups.The knee varus angle(TPA)and posterior tilt angle(PSA)and 12 months after operation,and the HSS knee score and SF-36 score were measured at the first and t 12 th month after operation,to evaluate the postoperative recovery of knee function.The above data usingstatistical data analysis software SPSS 22 for statistical analysis,to make comprehensive evaluation of the efficacy of the two groups.RESULTS:All patients were followed up in the two groups,no one was absence of follow-up.The number of follow-up months ranged from 12~30 months,with an average follow-up period of 16.9 months.The operation time of group A was(99.3 + 12)min,which group B was(91.8 + 10)min,P=0.006,the difference was statistically significant;12 months after operation,SF-36 score of group A is(81 + 6.2),and group B was(74.6 + 6.9),(P=0.000 < 0.05),the difference was statistically significant.According to the HSS knee function score,the excellent and good rates of group A and B were 89.3% and76.5%,respectively,The Chi square test results: x2 value 4.345,p=0.037< 0.05,Chi square test results: x2 value 4.345,p=0.037 < 0.05,and there were significant differences in the excellent and good rate of knee joint function between the two groups.The degree of knee joint after 12 months of operation,the group A was 2~122° and,and group B was 2~119°,which was slightly larger than the degree of group B.The injured knee tibial plateau between Immediately after operation and 12 months after operation,the PSA of group B were(10.35 + 2.31)°and(11.13 + 2.43)°,t=-4.466,P=0.000,the difference was statistically significant.CONCLUSION :For complex fracture of tibial plateau,especially the three columns fracture,strong fixation of the fracture of each column with a combination approach of treble plate,which compared with the treatment of treble column fracture combined with the treatment of double plate,it can be used for better anatomic reduction and rigid fixation of the fracture block,which can be more effective for postoperative rehabilitation exercise.The complicationwas not increased,but its effect was more accurate.The fixation of the posterior column complex fractures,taking the back side of the L approach has a better advantage.更多还原