| 摘要: |
| 目的:探讨微创接骨术配合“续骨活血汤”治疗胫骨平台前内侧塌陷骨折合并膝关节后外侧复合体损伤的疗效及并发症。方法:回顾性分析2015 年1 月—2018 年1 月收治的87 例胫骨平台前内侧塌陷骨折合并膝关节后外侧复合体损伤患者，均给予微创接骨术配合“续骨活血汤”治疗，术后康复运动锻炼，采用美国特种外科医院膝关节评分表(HSS)评价术后不同时间膝关节功能；观察术前、术后3 个月、术后6 个月、术后1 年膝关节胫骨平台畸形[ 内反角(TPA)、后倾角(PA)]、下肢外翻角度、外旋试验功能，并观察术后1 年并发症情况。结果:术后不同时间点HSS 疼痛、关节活动度、肌力、屈曲畸形、稳定性评分均高于术前(P <0.05)；术前患肢下肢力线外翻角度(–9.62±0.87)?，术后3 个月改善至术(3.26±1.03)?，术后6 个月改善至(3.84±1.21)?，术后1 年改善至(4.23±1.44)?，不同时间点比较差异均有统计学意义(P <0.05)；外旋试验评分为术前(13.57±2.56)分，术后3 个月下降至(7.34±1.24)分，术后6 个月下降至(4.03±1.02)分，术后1 年下降至(3.67±0.82)分，不同时间点比较差异均有统计学意义(P <0.05)；术后3 个月、术后6 个月、术后1 年TPA 均较术前降低，PA 较术前升高，差异均有统计学意义(P <0.05)；术后1 年内随访1 例关节面恢复欠佳，1 例骨折再塌陷，未出现感染、内固定失效者。结论:微创接骨术配合“续骨活血汤”治疗胫骨平台前内侧塌陷骨折合并膝关节后外侧复合体损伤是一种有效安全的治疗方案，并发症少、膝关节功能恢复快。 |
| 关键词: 胫骨平台骨折 膝关节后外侧复合体损伤 微创接骨术 续骨活血汤 |
| DOI：10.3969/j.issn.1007-6948.2020.02.027 |
| 投稿时间：2019-01-25 |
| 基金项目: |
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| Comparative Analysis of Efficacy of Minimally Invasive Plate Osteosynthesis Combined with“Xugu Huoxue Decoction” for Treatment of Tibial Plateau Fracture Combined with Posterolateral Corner Injuries |
| ZHOU Li,TANG Ji-ping,LIN Chun-yang |
| Shenzhen Luohu District Traditional Chinese Medicine Hospital,Shenzhen 518021, China |
| Abstract: |
| Objectives To discuss the curative effect and comparative analysis of minimally invasive plate osteosynthesis (MIPO) combined with the classical prescriptions “Xugu Huoxue Decoction” (XHD) for the treatment of tibial plateau fracture combined with posterolateral corner injuries. Methods A retrospective analysis was performed on 87 patients with tibial plateau fracture combined with posterolateral corner injuries ofn the knee joint admitted from January 2015 to January 2018; the patients in both groups were treated with MIPO combined with XHD, postoperative rehabilitation exercise, and hospital for spedcial surgery (HSS) was used to evaluate the knee function at different time point after surgery; the tibial plateau deformity of knee joint [TPA,PA], varus angle of lower limb, function of external rotation test, and complications preoperative, postoperative 3 months, postoperative 6 months, and postoperative 1 year after surgery were observed. Results Postoperative HSS pain, range of motion, muscle strength, flexion deformity and stability scores at different time points were higher than those before surgery (P <0.05); preoperative limb of lower limb strength line valgus angle for (–9.62 ±0.87)?, after 3 months at (3.26±1.03)?, after 6 months at (3.84 ±1.21)?, after 1 years improved to (4.23±1.44)?, the differences at different time points were statistically significant (P <0.05); preoperative external rotation test was (13.57±2.56) scores, 3 months after surgery was (7.34±1.24) scores, 6months after surgery was (4.03±1.02) scores, 1 year after surgery was (3.67±0.82) scores, the differences at different time points were statistically signi?cant (P<0.05); TPA increased 3 months after surgery, 6 months after surgery and 1 year after surgery (P<0.05), there was no signi?cant difference in postoperative time points (P>0.05); PA was lower 3 months after surgery, 6 months after surgery and 1 year after surgery (P<0.05); There were statistically signi?cant differences between 1 year after surgery, 3 months after surgery and 6 months after surgery (P<0.05); 1 case of poor recovery of articular surface and 1 case of fracture re-collapse without infection or failure of internal ?xation were followed up within 1 year after surgery. Conclusions MIPO combined with the classical prescriptions XHD for the treatment of tibial plateau fracture combined with posterolateral corner injuries is an effective and safe treatment with fewer complications and faster recovery of knee function, providing a reliable theoretical basis for clinical research. |
| Key words: Tibial plateau fracture posterolateral corner injuries of the knee joint minimally invasive plate osteosynthesis (MIPO) Xugu Huoxue Decoction |
