摘要
目的 探究股骨远端前外侧切口锁定钢板、前侧附加重建钢板在股骨远端Müller分型C2、C3型骨折治疗中的应用效果.方法 回顾性选取2018年3月至2022年6月在海安市人民医院接受治疗的120例股骨远端Müller分型C2、C3型骨折患者作为本研究的研究对象,按照治疗方法不同分为对照组和研究组,每组各60例.对照组患者接受前外侧切口锁定钢板治疗,研究组患者接受前外侧切口锁定钢板+前侧附加重建钢板治疗.门诊随访12个月,比较两组患者临床指标(手术时间、术中出血量、术中C型壁透视次数、术后下地康复时间、骨折愈合时间及骨折愈合率),治疗效果,膝关节功能,术后1、2、3、6个月的膝关节活动度,术后6个月患者的下肢最大伸膝肌力矩、最大内屈角及术后并发症发生情况.结果 两组手术时间、术中出血量、术中C型壁透视次数及骨折愈合率比较,差异均无统计学意义(P＞0.05);研究组术后下地康复时间、骨折愈合时间分别为(4.89±0.98)周、(6.61±1.06)个月,均短于对照组[(6.04±1.55)周、(8.45±1.02)个月],差异均有统计学意义(P＜0.05).研究组的治疗优良率为91.67％,高于对照组(78.33％),差异有统计学意义(P＜0.05).术后6个月,两组膝关节功能比较,差异无统计学意义(P＞0.05).术后1、2个月,两组膝关节活动度比较,差异均无统计学意义(P＞0.05);术后3、6个月,研究组患者的膝关节活动度分别为(103.56± 2.38)°、(115.68±2.77)°,均高于对照组[(92.45±5.46)°、(95.88±3.49)°],差异均有统计学意义(P＜0.05).术后6个月,研究组在触底即时及支撑末期时最大伸膝肌力矩分别为(22.66±1.26)、(18.99±2.15)Nm,均高于对照组[(19.56±2.01)、(17.58±1.87)Nm],最大内屈角分别为(3.56±0.26)°、(6.55±0.51)°,均小于对照组[(4.55± 0.31)°、(7.66±0.46)°],差异均有统计学意义(P＜0.05).两组随访期内并发症发生率比较,差异无统计学意义(P＞0.05).结论 使用前侧附加重建钢板治疗股骨远端Müller分型C2、C3型骨折,相比前外侧切口锁定钢板治疗,能够提高治疗的优良率,缩短术后下地康复时间和骨折愈合时间,改善远期膝关节活动度、最大伸膝肌力矩和最大内屈角.
Abstract
Objective To explore the application analysis of distal anterolateral incision locking plate and anterior additional reconstruc-tion plate in the treatment of distal Müller classification C2 and C3 fractures of femur.Methods A total of 120 patients with Müller classification C2 and C3 fractures of distal femur treated in Hai'an City People's Hospital from March 2018 to June 2022 were retrospectively selected as the re-search objects of this study,and they were divided into the control group and the study group according to the treatment methods,60 patients in each group.Patients in the control group received anterolateral incision locking plate treatment,and patients in the study group received anterior additional reconstruction plates.Ontpatient follow-up was 12 months.The clinical indexes(operative time,intraoperative blood loss,intraopera-tive C-wall fluoroscopy frequency time,postoperative rehabilitation time,fracture healing time,and fracture healing rate),therapeutic effect,knee function,knee motion at 1,2,3 and 6 months after operation,maximum knee extensor moment,maximum internal flexion angle at 6 months after operation,and postoperative complications of the two groups were compared.Results There were no statistically significant differences in op-erative time,intraoperative blood loss,intraoperative C-wall fluoroscopy time and fracture healing rate between the two groups(P＞0.05).The postoperative rehabilitation time and fracture healing time of the study group were(4.89±0.98)weeks,(6.61±1.06)months,respectively,which were shorter than those of the control group[(6.04±1.55)weeks,(8.45±1.02)months],the differences were statistically significant(P＜0.05).The treatment excellent and good rate of the study group was 91.67％,which was higher than that of the control group(78.33％),the difference was statistically significant(P＜0.05).There was no statistically significant difference in knee joint function between the two groups at 6 months after operation(P＞0.05).There were no statistically significant differences in knee joint motion between the two groups at 1 and 2 months after operation(P＞0.05);at 3 and 6 months after operation,the knee motion of the study group were(103.56±2.38)°,(115.68±2.77)°,respectively,which were higher than those of the control group[(92.45±5.46)°,(95.88±3.49)°],the differences were statistically significant(P＜0.05).After 6 months of operation,the maximum knee extensor torque of the study group at the time of botto-ming and at the end of support were(22.66±1.26)and(18.99±2.15)Nm,respectively,which were higher than those of the control group[(19.56±2.01)and(17.58±1.87)Nm],the maximum internal flexion angles were(3.56±0.26)° and(6.55±0.51)°,respectively,which were lower than those of the control group[(4.55±0.31)° and(7.66±0.46)°],and the differences were statistically significant(P＜0.05).There was no statistically significant difference in the incidence of complications between the two groups(P＞0.05).Conclusion Compared with anterolateral incisions locking plate therapy,the use of anterolateral additional reconstruction plate in the treatment of distal femoral Müller type C2 and C3 fractures can improve the rate of good treatment,shorten the postoperative rehabilitation time and fracture healing time,and improve the long-term knee motion,maximum knee extensor moment and maximum internal flexion angle.
基金项目
江苏省科学技术厅重点研发计划项目(BE201900107)
NETL
NSTL
维普
万方数据