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(mTPF)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Wahlquist 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。
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 coronal 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(operation 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 operation 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 clinically according to the actual situation.
作者
陆栋
黄国伟
周枫
汤志军
王思奇
LU Dong;HUANG Guo-wei;ZHOU Feng(Department of Orthopedic Center,Jiangyin People's Hospital,Jiangyin Jiangsu 214400,China)
出处
《临床和实验医学杂志》
2024年第16期1731-1734,共4页
Journal of Clinical and Experimental Medicine
基金
江苏省青年科技项目(编号:KJXW20200134)。
