Comparison of modified double-reverse traction and traditional open reduction in the treatment of tibial plateau fractures
李焕坤 1李艳红 1黄东杰 1胡栢均 1高大伟 1吴宇峰 1唐剑邦 1陈红俊 1桑莉莉 1张以芳
扫码查看
点击上方二维码区域，可以放大扫码查看
作者信息
1. 广州中医药大学附属中山中医院骨三科，中山 528400
折叠
摘要
目的 比较改良双反牵引技术与传统切开复位治疗胫骨平台骨折的疗效。 方法 回顾性分析2017年1月至2022年12月广州中医药大学附属中山中医院骨三科行手术治疗的70例Schatzker Ⅳ、Ⅴ型胫骨平台骨折患者资料。根据治疗方式不同分为2组：观察组（使用改良双反牵引技术治疗）和对照组（采用传统切开复位治疗）。观察组37例，男20例，女17例；年龄（44.6±13.5）岁；骨折根据Schatzker分型：Ⅳ型9例，Ⅴ型28例。对照组33例，男18例，女15例；年龄（45.9±13.7）岁；骨折根据Schatzker分型：Ⅳ型10例，Ⅴ型23例。术后观察比较两组患者手术时间、主手术切口长度、术中出血量、出院前Rasmussen影像学评分、术后6个月美国特种外科医院（HSS）膝关节功能评分、术后6个月疼痛视觉模拟评分（VAS）、术后6个月骨折愈合率和并发症发生率。 结果 两组患者术前一般资料比较差异均无统计学意义（P>0.05），具有可比性。所有患者术后获（14.3±1.4）个月随访。观察组患者的手术时间[（113.9±11.4）min]、主手术切口长度[4（4,5）cm]、术中出血量[30（20,35）mL]、术后6个月疼痛VAS评分[0（0,0）分]、术后6个月HSS评分[（89.8±3.1）分]均显著优于对照组[（151.8±10.4）min，6（6,7）cm、55（50,65）mL、0（0,1）分、（86.0±3.5）分]，差异均有统计学意义（P<0.05），而患者出院前Rasmussen影像学评分、术后6个月骨折愈合率、并发症发生率两组间差异均无统计学意义（P>0.05）。 结论 双反牵引技术微创治疗Schatzker Ⅳ、Ⅴ型胫骨平台骨折相较于传统切开复位，手术时间更短、手术切口更小、术中出血量更少，术后疼痛评分和膝关节功能评分优势明显，疗效显著，值得临床应用推广。 Objective To compare the curative effects between modified double-reverse traction technique and traditional open reduction in the treatment of tibial plateau fractures. Methods A retrospective study was conducted to analyze the data of 70 patients with Schatzker type Ⅳ-Ⅴ tibial plateau fracture who had undergone surgical treatment at The Third Department of Orthopaedics, Zhongshan Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Traditional Chinese Medicine from January 2017 to December 2022. The patients were divided into an observation group treated with modified double-reverse traction and a control group treated with traditional open reduction. In the observation group of 37 cases, there were 20 males and 17 females with an age of (44.6±13.5) years, and 9 cases of type Ⅳ and 28 cases of type V by the Schatzker classification in the control group of 33 cases, there were 18 males and 15 females with an age of (45.9±13.7) years, and 10 cases of type Ⅳ and 23 cases of type Ⅴ by the Schatzker classification. The 2 groups were compared in terms of operation time, length of main incision, intraoperative blood loss, Rasmussen imaging score before discharge, and knee function score of American Hospital for Special Surgery (HSS), Visual Analogue Scale (VAS), fracture healing and complications at 6 months postoperatively. Results There was no significant difference in the preoperative general data between the 2 groups, showing group comparability (P>0.05). All patients were followed up for (14.3±1.4) months. The observation group was significantly better than the control group in operation time [(113.9±11.4) min versus (151.82±10.37) min], length of main incision [4 (4, 5) cm versus 6 (6, 7) cm], intraoperative blood loss [30 (20, 35) mL versus 55 (50, 65) mL], VAS [0 (0, 0) point versus 0 (0, 1) points] and HSS score [(89.8±3.1) points versus (86.0±3.5) points] (P<0.05). There were no significant differences between the 2 groups in Rasmussen imaging score before discharge, or fracture healing rate or complication rate at 6 months postoperatively (P>0.05). Conclusion In the treatment of Schatzker type Ⅳ-Ⅴ tibial plateau fractures, modified double-reverse traction technique is worthy of clinical application and promotion, because it is advantageous over traditional open reduction in terms of shorter operation time, smaller surgical incision, less intraoperative blood loss, less postoperative pain and better knee function.
Abstract
Objective To compare the curative effects between modified double-reverse traction technique and traditional open reduction in the treatment of tibial plateau fractures. Methods A retrospective study was conducted to analyze the data of 70 patients with Schatzker type Ⅳ-Ⅴ tibial plateau fracture who had undergone surgical treatment at The Third Department of Orthopaedics, Zhongshan Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Traditional Chinese Medicine from January 2017 to December 2022. The patients were divided into an observation group treated with modified double-reverse traction and a control group treated with traditional open reduction. In the observation group of 37 cases, there were 20 males and 17 females with an age of (44.6±13.5) years, and 9 cases of type Ⅳ and 28 cases of type V by the Schatzker classification in the control group of 33 cases, there were 18 males and 15 females with an age of (45.9±13.7) years, and 10 cases of type Ⅳ and 23 cases of type Ⅴ by the Schatzker classification. The 2 groups were compared in terms of operation time, length of main incision, intraoperative blood loss, Rasmussen imaging score before discharge, and knee function score of American Hospital for Special Surgery (HSS), Visual Analogue Scale (VAS), fracture healing and complications at 6 months postoperatively. Results There was no significant difference in the preoperative general data between the 2 groups, showing group comparability (P>0.05). All patients were followed up for (14.3±1.4) months. The observation group was significantly better than the control group in operation time [(113.9±11.4) min versus (151.82±10.37) min], length of main incision [4 (4, 5) cm versus 6 (6, 7) cm], intraoperative blood loss [30 (20, 35) mL versus 55 (50, 65) mL], VAS [0 (0, 0) point versus 0 (0, 1) points] and HSS score [(89.8±3.1) points versus (86.0±3.5) points] (P<0.05). There were no significant differences between the 2 groups in Rasmussen imaging score before discharge, or fracture healing rate or complication rate at 6 months postoperatively (P>0.05). Conclusion In the treatment of Schatzker type Ⅳ-Ⅴ tibial plateau fractures, modified double-reverse traction technique is worthy of clinical application and promotion, because it is advantageous over traditional open reduction in terms of shorter operation time, smaller surgical incision, less intraoperative blood loss, less postoperative pain and better knee function.
万方数据