不同手術(shù)方式在最佳時間內(nèi)對復雜性脛骨平骨折合并膝關(guān)節(jié)周圍軟組織損傷的療效

　　[摘要] 目的 探討不同術(shù)式在最佳時間內(nèi)對復雜性脛骨平臺合并膝關(guān)節(jié)周圍軟組織損傷的效果。 方法 回顧性分析安徽省第二人民醫(yī)院在2013年10月～2017年9月收治的60例復雜脛骨平臺患者的臨床資料，按照治療方法不同分為A組和B組，每組各30例。A組采用前內(nèi)側(cè)切口，B組采用前外側(cè)和后內(nèi)側(cè)聯(lián)合切口，均于骨折后6～7 d最佳手術(shù)時間內(nèi)實施手術(shù)。觀察并比較兩組患者手術(shù)時間、術(shù)中平均出血量、術(shù)后感染率和引流量、切口愈合不良率、皮膚缺血壞死率及術(shù)后關(guān)節(jié)周圍軟組織恢復有效率。 結(jié)果 兩組患者手術(shù)時間比較，差異無統(tǒng)計學意義（P > 0.05）；A組出血量、術(shù)后引流量均低于B組，差異有統(tǒng)計學意義（P < 0.05）；B組術(shù)后感染率、切口愈合不良率和皮膚缺血壞死發(fā)生率均低于A組，差異有統(tǒng)計學意義（P < 0.05）。兩組術(shù)后骨折愈合時間、內(nèi)固定失敗率及膝關(guān)節(jié)周圍韌帶恢復狀況比較，差異均無統(tǒng)計學意義（P > 0.05）。B組膝關(guān)節(jié)評分系統(tǒng)有效率高于A組，差異有統(tǒng)計學意義（P < 0.05）。 結(jié)論 復雜脛骨平臺骨折合并膝關(guān)節(jié)周圍軟組織損傷在傷后最佳時間內(nèi)采用前外側(cè)和后內(nèi)側(cè)聯(lián)合切口術(shù)式，可促進患者快速康復，降低術(shù)后并發(fā)癥發(fā)生率，值得臨床進一步推廣應用。
　　[關(guān)鍵詞] 復雜脛骨平臺骨折；周圍軟組織損傷；內(nèi)固定；康復鍛煉
　　[中圖分類號] R683.42 [文獻標識碼] A [文章編號] 1673-7210（2018）02（c）-0075-05
　　The efficacy of different surgical methods on the complicated tibial plateau fracture combined with soft tissue injury around the knee joint in the optimal time
　　MIAO Benkuan YU Runze
　　Department of Orthopaedics， Second People"s Hospital of Anhui Province， Anhui Province， Hefei 340000， China
　　[Abstract] Objective To investigate the efficacy of different surgical methods on the complicated tibial plateau fracture combined with soft tissue injury around the knee joint in the optimal time. Methods From October 2013 to September 2017， clinical data of 60 patients with complicated tibial plateau fracture combined with soft tissue injury around the knee joint treated in the Second People"s Hospital of Anhui Province were retrospectively analyzed and divided into group A and group B by different surgical methods， with 30 cases in each group. Group A was treated with anteromedial incision and group B was treated with anterolateral combined with posterior medial incision， both performed 6-7 d after the fracture within the optimal timing. The operation time， average bleeding volume， incidence of postoperative infection， drainage volume， the incidences of the delayed healing， the skin necrosis and the postoperative soft tissue injury around the knee joint in the two groups were compared. Results There was no statistically significant difference in the operation time between the two groups（P > 0.05）； The average bleeding volume and postoperative drainage volume in group A were lower than those of group B， with statistically significant differences （P < 0.05）； the incidences of the delayed healing， postoperative infection and skin necrosis in group B were lower than those of group A， with statistically significant differences（P < 0.05）. There were no statistically significant differences in the postoperative fracture healing time， incidence of internal fixation failure and recovery of ligaments around the knee between the two groups （P > 0.05）. The effective rate of knee joint scoring systom in group B was higher than that of group A， with statistically significant differences （P < 0.05）. Conclusion The anterolateral combined with posterior medial incisionin the optimal time can promote the recovery in patients with complicated tibial plateau fracture combined with soft tissue injury around the knee joint and reduce the incidence of postoperative complications， which is worthy of further clinical application.

相關(guān)熱詞搜索：脛骨 膝關(guān)節(jié) 軟組織 復雜性 骨折