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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:

第24卷

期數:

2012年06期

頁碼:

29-33

欄目:

臨床研究

出版日期:

2012-06-30

文章信息/Info

Title:

Comparison study on the curative effects between manipulative reduction and percutaneous fixation with fish-lip pincers and open reduction and internal fixation with plate in tibial plateau fracture

作者:

王戰(zhàn)朝¹; 尚延春¹; 閆永昌²; 孫永強³; 張江濤¹; 孟慶陽¹; 閆占民⁴

1.河南省洛陽正骨醫(yī)院，河南洛陽471002；
2.鄭州大學醫(yī)學院，河南鄭州450001；
3.河南省中醫(yī)院，河南鄭州450002；
4.河南省登封市骨科醫(yī)院，河南鄭州452470

Author(s):

WANG Zhan- chao*; SHANG Yan-chun; YAN Yong-chang; SUN Yong-qiang;  ZHANG Jiang- tao; MENG Qing-yang; YAN Zhan-min.*

Luoyang Orthopedic-Traumatological Hospital,Luoyang 471002,Henan,China

關鍵詞:

脛骨骨折　整復脫位　骨折固定術; 內　治療; 臨床研究性　脛骨平臺　魚嘴鉗

Keywords:

Tibial fractures; Reducting luxation; Fracture fixation; internal;  Therapies; investigational; Tibial plateau; Fish-lip pincers

摘要:

目的：比較分析手法復位魚嘴鉗經皮固定與切開復位鋼板內固定治療脛骨平臺骨折的臨床療效。方法：將納入研究的237例 脛骨平臺骨折患者隨機分為2組，采用手法整復魚嘴鉗經皮固定126例，采用切開復位鋼板內固定111例。其中SchatzkerⅠ型30 例，Ⅱ型41例，Ⅳ型71例，Ⅴ型95例。記錄并比較2組患者的膝關節(jié)疼痛、行走能力、伸膝、關節(jié)活動度、關節(jié)穩(wěn)定性評分及膝 關節(jié)功能總分情況。記錄并比較2組患者的關節(jié)面塌陷、髁部變寬、膝關節(jié)內外翻畸形評分及膝關節(jié)X線總分情況。參照 Rasmussen脛骨髁部骨折膝關節(jié)功能評分標準及Rasmussen脛骨髁部骨折復位解剖學評分標準評定2組患者的療效。結果：手法復 位魚嘴鉗經皮固定組：拆除魚嘴鉗時間1.5～2.5個月，中位數2個月；去除鋼針時間2.5～4.5個月，中位數3.5個月；10例于術 后7 d至3個月出現針道流液、局部皮膚發(fā)紅，經換藥處理后愈合，無竇道、骨髓炎形成；126例中有122例得到隨訪，3例失訪脫 落，1例合并糖尿病剔除；隨訪時間1～4年；骨折愈合時間3～6個月，中位數4.8個月。切開復位鋼板內固定組：12例術后出現 局部皮膚感染、壞死，10例經換藥處理后治愈，2例部分鋼板外露，經換藥、皮瓣移位后治愈。111例中有103例得到隨訪，6例 失訪脫落，2例納入后未接受本試驗剔除；隨訪時間1～4年；骨折愈合時間3～9個月，中位數6.9個月；內固定取出時間為術后 12～21個月，中位數為術后15.3個月。2組患者的膝關節(jié)疼痛、行走能力、伸膝、關節(jié)活動度、關節(jié)穩(wěn)定性評分及膝關節(jié)功能總 分比較，差異均無統計學意義（�玹=1.655,P=0.200；t=0.153,P=0.696；t=0.860,P=0.355；t=0.691,P=0.407； t=1.697,P=0.194；t=1.845,P��=0.176）。2組患者的關節(jié)面塌陷、髁部變寬、膝關節(jié)內外翻畸形評分及膝關節(jié)X線總分比 較，差異均有統計學意義，切開復位鋼板內固定組膝關節(jié)X線評分高于手法復位魚嘴鉗經皮固定組（�玹=8.695,P=0.004； t=9.601,P=0.002；t=11.493,P=0.001；t=7.935,P��=0.005）。2組患者膝關節(jié)功能比較，差異無統計學意義（�玓=-0.236，P ��=0.814）；2組患者骨折復位效果比較，切開復位鋼板內固定組優(yōu)于手法復位魚嘴鉗經皮固定組（�玓=-3.223，P��=0.001） 。結論：對于SchatzkerⅠ、Ⅱ、Ⅳ、Ⅴ型脛骨平臺骨折患者而言，與手法整復魚嘴鉗經皮固定相比，手術切開復位內固定具有 骨折復位效果好的優(yōu)勢，但是二者對患者膝關節(jié)功能的療效相當。二者各有優(yōu)缺點，術者應根據自身操作技能水平及醫(yī)院條件 等綜合考慮，選擇適當的固定方式。

Abstract:

Objective:To compare and analyze the clinical curative effects between manipulative reduction and percutaneous fixation with fish-lip pincers and open reduction and internal fixation with plate in tibial plateau fracture.Methods:Two hundred and thirty-seven patients with tibial plateau fracture enrolled into the study were randomly divided into 2 groups.One hundred and twenty-six patients were administrated with manipulative reduction and percutaneous fixation with fish-lip pincers,while the others were administrated with open reduction and internal fixation with plate.Thirty patients with SchatzkerⅠtibial plateau fracture,41 patients with SchatzkerⅡtibial plateau fracture,71 patients with SchatzkerⅣ tibial plateau fracture and 95 patients with SchatzkerV tibial plateau fracture were enrolled into the study.Such scores as knee pain,walking ability,knee extension,range of motion(ROM),joint stability and total scores of knee joint function were recorded and compared between the 2 groups.Such scores as collapse of articular facet,broaden of condyles,varus -valgus deformity of knee joint and total scores of X-ray for knee joint were recorded and compared between the 2 groups.The curative effects were evaluated according to Rasmussen scoring standards of knee joint function for tibial condyles fracture and Rasmussen scoring standards of anatomy for tibial condyles fracture reduction.Results:For manipulative reduction and percutaneous fixation with fish- lip pincers group:time of removing fish-lip pincer is 1.5-2.5 months with median time of 2 months.Time of removing steel needle is 2.5-4.5 months with median time of 3.5 months.Ten cases with needle passage fluids and local skin redness were found from 7 days to 3 months after operation,while they were healed after dressing change without forming sinus and osteomyelitis.Among the 126 cases,122 cases were followed up,3 cases were lost to follow-up and 1 case was rejected for diabetes.Follow-up time was 1-4 years.Fracture healing time was 3-6 months with median time of 4.8 months.For open reduction and internal fixation with plate group:Twelve cases with local skin infection and necrosis were found,among which 10 cases were healed after dressing change,2 cases with partly steel exposure were healed after dressing change and flap transposition.Among the 111 cases,103 cases were followed up,6 cases were lost to follow-up and 2 cases were rejected for refusing to accept this test.Follow-up time was 1-4 years.Fracture healing time was 3-9 months with median time of 6.9 months.Time of removing internal fixation is 12-21 months with median time of 15.3 months after operation.There was no statistical difference in scores of knee pain,walking ability,knee extension,joint ROM,joint stability and total scores of knee joint function between the 2 groups (�玹=1.655,P=0.200;t=0.153,P=0.696;t=0.860,P=0.355;t=0.691,P=0.407;t=1.697,P=0.194;t=1.845,P��=0.176).There was statistical difference in scores of collapse of articular facet,broaden of condyles,varus-valgus deformity of knee joint and total scores of X-ray for knee joint between the 2 groups,X-ray scores of internal fixation group were higher than those of percutaneous fixation group (�玹=8.695,P=0.004;t=9.601,P=0.002;t=11.493,P=0.001;t=7.935,P��=0.005).There was no statistical difference in knee joint function between the 2 groups(�玓=-0.236,P��=0.814).Fracture reduction effect of open reduction and internal fixation with plate was better than that of manipulative reduction and percutaneous fixation with fish-lip pincers (�玓=-3.223,P��=0.001).Conclusion:Compared with the method of manipulative reduction and percutaneous fixation with fish-lip pincers,open reduction and internal fixation with plate has the advantage of better fracture reduction effect on patients with SchatzkerⅠ,Ⅱ,ⅣandⅤtibial plateau fractures,while the 2 methods have the similar curative effects on knee joint function.Considering the 2 methods have their own advantages and disadvantages,the performers should select the proper fixation method according to their own operation skill levels and hospital conditions.

備注/Memo

備注/Memo:

2012-02-07收稿2012-03-22修回
基金項目：國家中醫(yī)藥行業(yè)科研專項課題（200807049）

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更新日期/Last Update: 2012-06-30