LISS钢板与解剖钢板内固定治疗胫骨平台骨折临床对比分析

发布时间：2018-06-29 23:37

本文选题：胫骨平台骨折 + 微创内固定系统　；参考：《中南大学》2014年硕士论文

【摘要】：目的：通过回顾性分析,比较LISS和解剖钢板内固定两种手术方式治疗复杂胫骨平台骨折的适应症及临床疗效,为今后选择合适手术方法提供临床依据及参考。方法：利用中南大学湘雅二医院病历检索系统及病案科保存的2011年1月至2013年1月明确诊断为胫骨平台骨折而且符合本次研究纳入标准的45例病例,按照手术方法分为解剖钢板内固定及LISS钢板内固定组,收集其影像学及临床病例资料,通过电话及门诊复诊方式进行随诊,掌握患者1.术中情况：麻醉方式,手术入路,切口大小,内固定方式,术中出血量,手术时间2.术后处理：是否使用外固定支架,何时开始膝关节锻炼,何时负重3.愈合情况：伤口情况,拆线时间,骨痂形成时间,骨愈合时间,膝关节屈伸范围,按Merchant标准评定膝关节功能并进行统计学分析4.并发症：是否出现感染、关节僵硬、创伤性关节炎、骨折不愈合、内固定松动断裂等并发症,是否有非计划再次手术。根据所收集资料,着重于术中指标、骨折愈合情况及膝关节功能Merchant评分三方面对两者进行统计分析,确定是否有统计学差异,判断二者临床疗效优劣,并在各个方面进行细化比较。结果：符合入组条件的45例病例中共44例获得回访并完成膝关节功能评价,平均随访时间13.84月。其中,LISS组17例,平均手术时间为2.32小时,平均手术切口长度为8.82cm,平均术中出血量为226.48ml,平均术后引流量为130.59ml,术后1例创伤性关节炎,无深部感染、骨延迟愈合或者不愈合、内固定松动或断裂等发生,并发症发生率为5.89%,平均骨折愈合时间为12.71周,平均完全负重时间为14.94周,按Merchant标准评定膝关节功能,优10例,良4例,中3例,差0例,优良率82.35%；解剖钢板组27例,平均手术时间为2.84小时,平均手术切口长度为19.67cm,平均术中出血量为318.52ml,平均术后引流量为197.78ml,术后3例创伤性关节炎,1例延迟愈合,无深部感染、内固定松动或断裂等发生,并发症发生率为14.81%,平均骨折愈合时间为13.74周,平均完全负重时间为15.74周,按Merchant标准评定膝关节功能,优16例,良6例,中4例,差1例,优良率81.84% 两组患者上述指标中,平均手术时间、平均手术切口长度及平均术中出血量和术后引流量差异有统计学意义,LISS组均小于解剖钢板组,并发症发生率、平均骨折愈合时间、完全负重时间和Merchant膝关节功能评分方面差异无统计学意义。结论：LISS技术相对于解剖钢板内固定术,在缩小患者手术伤口、减少手术时间和术中术后出血量方面具有显著优势(P0.05)；在术后并发症发病率,术后骨折临床愈合时间和完全负重时间方面,两者无明显差异(P0.05),且膝关节功能恢复方面两者表现均优良。
[Abstract]:Objective: to compare the indications and clinical effects of Liss and anatomical plate internal fixation in the treatment of complex tibial plateau fractures by retrospective analysis, and to provide clinical basis and reference for the selection of appropriate surgical methods in the future. Methods: from January 2011 to January 2013, 45 cases of tibial plateau fractures were definitely diagnosed by the medical record department and the medical records department of Xiangya second Hospital of Central South University. According to the operation method, the patients were divided into two groups: anatomical plate internal fixation and Liss plate internal fixation. The imaging and clinical data were collected, and the patients were followed up by telephone and out-patient consultation. Intraoperative conditions: anesthesia, operative approach, incision size, internal fixation, intraoperative bleeding, operative time 2. Postoperative management: whether to use external fixator, when to start knee joint exercise, when to load 3. Healing condition: wound condition, unthread time, callus formation time, bone healing time, knee joint flexion and extension range, the knee joint function was evaluated according to Merchant standard and statistically analyzed 4. 5%. Complications: infection, stiffness of joints, traumatic arthritis, nonunion of fractures, loosening of internal fixation and other complications, unscheduled reoperation. According to the data collected, the statistical analysis was carried out in three aspects: intraoperative index, fracture healing condition and knee joint function Merchant score, to determine whether there was a statistical difference, and to judge the clinical efficacy of the two. And detailed comparison in all aspects. Results: a total of 44 patients who met the criteria of entering the group received a return visit and completed the evaluation of knee joint function. The average follow-up time was 13.84 months. The average operative time was 2.32 hours, the average operative incision length was 8.82 cm, the average intraoperative bleeding was 226.48 ml, the average postoperative drainage was 130.59 ml, and one case had traumatic arthritis, no deep infection, delayed union or non-union. The incidence of internal fixation loosening or fracture was 5.89, the average fracture healing time was 12.71 weeks and the average complete weight loading time was 14.94 weeks. According to Merchant criterion, the knee joint function was excellent in 10 cases, good in 4 cases, fair in 3 cases, poor in 0 cases, and excellent and good rate 82.35%. In the anatomic plate group, the average operative time was 2.84 hours, the average operative incision length was 19.67 cm, the average intraoperative bleeding was 318.52 ml, the average postoperative drainage was 197.78 ml, and 1 case of traumatic arthritis was delayed healing without deep infection. The incidence of complications was 14.81, the average healing time of fracture was 13.74 weeks, and the average time of complete weight loading was 15.74 weeks. According to Merchant criterion, the knee joint function was assessed as excellent in 16 cases, good in 6 cases, fair in 4 cases, poor in 1 case. In 81.84% of the two groups, the average operative time, the average operative incision length, the average intraoperative bleeding volume and the postoperative drainage volume were significantly lower in the Liss group than in the anatomic plate group, and the incidence of complications was significantly lower in the Liss group than in the anatomic plate group. There was no significant difference in average fracture healing time, total weight loading time and Merchant knee function score. Conclusion compared with internal fixation with anatomical plate, the technique of WLISS has significant advantages in reducing the surgical wound, reducing the operative time and the amount of blood lost during and after the operation (P0.05), the incidence of postoperative complications, There was no significant difference in clinical healing time and total weight bearing time between the two groups (P0.05), and both of them had good performance in the recovery of knee joint function.
【学位授予单位】：中南大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R687.3

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