Efficacy comparison between modified two-window and conventional single-window posteromedial inverted L-shaped approach for reduction and internal fixation of flexion-inversion tibial plateau fractures
Objective To compare the efficacy of reduction and internal fixation of flexion-inversion tibial plateau fractures with a modified two-window and conventional single-window posteromedial inverted L-shaped approach.Methods A retrospective cohort study was used to analyze the clinical data of 44 patients with flexion-inversion tibial plateau fractures admitted to the Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University from January 2018 to December 2022,including 22 males and 22 females,aged 31-58 years[(44.4±9.l)years].Among them,25 patients were injured on the left side and 19 on the right.A total of 23 patients were treated with the conventional single-window posteromedial inverted L-shaped approach(conventional single-window approach group),while the other 21 with the modified two-window posteromedial inverted L-shaped approach(modified two-window approach group).The length of surgical incision,operation time,intraoperative blood loss,postoperative drainage volume,and postoperative hospital stay were compared between the two groups.The articular step-offs,medial tibial plateau angles(mTPA),tibial posterior slope angles(PSA),and Rasmussen radiological scores at 3 days,3 months after surgery and at the last follow-up were evaluated in the two groups.The visual analogue scale(VAS)scores before surgery,at 7 days and 3 months after surgery,data of extension-flexion motion of the knee joint at 7 days after surgery and Hospital for Special Surgery(HSS)knee function scores at 3 and 6 months after surgery and at the last follow-up were compared between the two groups.At the last follow-up,the fracture healing was observed.The postoperative incidence of complications such as thrombosis and poor wound healing was compared between the two groups.Results All the patients were followed up for 12-18 months[(15.7±3.2)months].The operation time of the modified two-window approach group was(121.6±19.2)minutes,significantly shorter than(149.5±22.4)minutes of the conventional single-window approach group(P＜0.01).There were no statistically significant differences in the length of surgical incision,intraoperative blood loss,postoperative drainage volume,or postoperative hospital stay between the two groups(P＞0.05).At 3 days,3 months after surgery and at the last follow-up,the articular step-offs of the modified two-window approach group were 0.7(0.5,0.9)mm,1.0(0.8,1.1)mm and 0.9(0.8,1.0)mm respectively,significantly shorter than 1.0(0.7,1.2)mm,1.1(1.0,1.3)mm and 1.1(0.9,1.2)mm of the conventional single-window approach group(P＜0.05 or 0.01);the mTPA of the modified two-window approach group was 87.0(86.0,87.0)°,87.0(86.0,87.0)oand 86.0(85.5,87.0)orespectively,significantly larger than 85.0(84.0,86.0)°,85.0(84.0,86.0)°and 85.0(84.0,86.0)°of the conventional single-window approach group(P＜0.01);the Rasmussen radiological scores of the modified two-window approach group were(17.0±0.9)points,16.0(15.0,17.0)points and 16.0(15.0,16.0)points respectively,significantly higher than(16.4±1.1)points,13.0(13.0,15.0)points and 14.0(13.0,15.0)points of the conventional single-window approach group(P＜0.05 or 0.01);no significant differences in the PSA were found between the two groups(P＞0.05).There were no significant differences in VAS scores between the two groups before surgery and at 3 months after surgery(P＞0.05),while the VAS score at 7 days after surgery was 3.0(3.0,3.0)points in the modified two-window approach group,significantly lower than 3.0(3.0,4.0)points of the conventional single-window approach group(P＜0.05).There was no significant difference in the VAS score at 3 months after surgery between the two groups(P＞0.05).The extension-flexion motion of the knee joint at 7 days after surgery was 90.0(85.0,95.0)° in the modified two-window approach group,higher than 80.0(75.0,85.0)° of the conventional single-window approach group(P＜0.01).The HSS knee function score at 3 months after surgery was(67.9±2.8)points in the modified two-window approach group,higher than(66.1±2.7)points of the conventional one-window approach group(P＜0.05).There were no significant differences in the HSS knee function scores at 6 months after surgery and at the last follow-up between the two groups(P＞0.05).At the last follow-up,bone union was observed in both groups.One patient in the conventional single-window approach group developed partial popliteal vein thrombosis,with a complication rate of 4.4％(1/23);while one patient in the modified two-window approach group had poor healing of the incision postoperatively,with a complication rate of 4.8％(1/21)(P＞0.05).Conclusion Compared with the conventional single-window approach,the modified two-window posteromedial inverted L-shaped approach has the advantages of shorter operation time,better reduction quality,early pain relief,and better restoration of knee joint extension-flexion motion and joint function in the reduction and internal fixation of flexion-inversion tibial plateau fractures.
NETL
NSTL
万方数据
