摘要
目的 探究前外联合后内侧入路手术方案治疗伴冠状面半脱位的Wahlquist C型内侧胫骨平台骨折(mT-PF)患者的疗效.方法 前瞻性选取2020年8月至2022年8月江阴市人民医院收治的69例伴冠状面半脱位的Wahl-quist C型mTPF患者,按照信封法将其分为对照组(n=34)和研究组(n=35).对照组接受单一后侧倒"L"形入路手术方案,研究组接受前外联合后内侧入路手术方案.随访12个月,比较组间临床指标(手术时间、切口长度、术中失血量、术后引流量及住院时间);术前、术后1、3、6、12个月的疼痛[视觉模拟评分法(VAS)评分]情况;术前及术后1、3、6、12个月的膝关节功能[美国特种外科医院(HSS)评分];术后即刻、术后12个月的影像学资料(内翻角、后倾角、活动度);术后12个月的生活质量情况[世界卫生组织生存质量测定简表(WHOQOL-BREF)评分],并于末次随访时评估疗效,记录并发症情况.结果 两组间手术时间、切口长度、术中失血量、术后引流量、住院时间比较,差异均无统计学意义(P＞0.05).研究组术后1、3、6个月的VAS评分分别为(3.45±0.56)、(3.01±0.34)、(2.56±0.38)分,均低于对照组[(3.88±0.61)、(3.37±0.33)、(2.98±0.42)分],差异均有统计学意义(P＜0.05);术前及术后12个月,组间VAS评分比较,差异均无统计学意义(P＞0.05).术前及术后1、3、6、12个月,两组间HSS评分比较,差异均无统计学意义(P＞0.05).术后12个月,研究组内翻角、后倾角分别为(85.11±4.32)°、(5.03±0.35)°,均低于对照组[(88.98±3.16)°、(6.11±0.36)°],活动度为(113.26±13.66)°,高于对照组[(106.56±12.06)°],差异均有统计学意义(P＜0.05).术后12个月,两组间WHOQOL-BREF评分比较,差异均无统计学意义(P＞0.05).两组治疗优良率比较,差异无统计学意义(P＞0.05).两组并发症发生率比较,差异无统计学意义(P＞0.05).结论 采用前外联合后内侧入路手术方案治疗伴有冠状面半脱位的Wahlquist C型mTPF患者的疗效和安全性与单一后侧倒"L"形入路手术方案相当,但在术后影像学指标、疼痛程度方面有一定优势,临床应根据实际情况灵活选择.
Abstract
Objective To explore the efficacy of anterior and external combined with posterior medial approach in the treatment of type Wahlquist C medial tibial plateau fracture(mTPF)with coronal subluxation.Methods A total of 69 patients with Wahlquist C mTPF with coro-nal subluxation admitted to Jiangyin People's Hospital from August 2020 to August 2022 were prospectively selected and divided into the control group(n=34)and the study group(n=35)according to envelope method.The control group received single posterior"L"approach,and the study group received an anterolateral combined posteromedial approach.The patients were followed up for 12 months.The clinical indexes(opera-tion time,incision length,intraoperative blood loss,postoperative drainage volume and hospitalization time),pain[visual analogue scale(VAS)score]before operation and 1,3,6 and 12 months after operation,knee joint function[Hospital for special surgery(HSS)score]before operation and 1,3,6 and 12 months after operation,and imaging data(varus angle,posterior slope angle and activity)immediately after operation and 12 months after operation,the quality of life[World Health Organization Quality of Life-BREF(WHOQOL-BREF)score]12 months after opera-tion were compared between the two groups,and the efficacy was evaluated at the last follow-up,and the complications were recorded.Results There were no significant differences in operation time,incision length,intraoperative blood loss,postoperative drainage volume and hospitalization time between the two groups(P＞0.05).The VAS scores of the study group at 1,3 and 6 months after operation were(3.45±0.56),(3.01±0.34),(2.56±0.38)points,respectively,which were lower than those of the control group[(3.88±0.61),(3.37±0.33),(2.98±0.42)points],the differences were statistically significant(P＜0.05);there were no significant differences in VAS score between the two groups before operation and at 12 months after operation(P＞0.05).There were no significant differences in HSS score between the two groups before operation and 1,3,6 and 12 months after operation(P＞0.05).At 12 months after operation,the varus angle and posterior slope angle of the study group were(85.11±4.32)° and(5.03±0.35)°,respectively,which were lower than those of the control group[(88.98±3.16)° and(6.11±0.36)°],and the activity was(113.26±13.66)°,which was higher than that of the control group[(106.56±12.06)°],the differences were statistically significant(P＜0.05).At 12 months after operation,there was no significant difference in WHOQOL-BREF score between the two groups(P＞0.05).There was no significant difference in the excellent and good rate between the two groups(P＞0.05).There was no significant difference in the incidence of complications between the two groups(P＞0.05).Conclusion Compared with the single posterior inverted"L"approach,the anterior and external combined posterior medial approach to treat Wahlquist C mTPF patients with coronal subluxation has good efficacy and safety,and certain advantages in postoperative imaging and VAS score,which should be selected flexibly clini-cally according to the actual situation.
维普
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