RESUMEN
Objective:To study the clinical efficacy of our modified double reverse traction technique in the treatment of tibial plateau fractures.Methods:A retrospective study was conducted of the 66 patients with tibial plateau fracture who had been treated by our modified double reverse traction technique at Articular Department, Zhongshan Hospital of Traditional Chinese Medicine from March 2019 to December 2021. There were 37 males and 29 females, with an age of (44±14) years. The double reverse traction technique was used in all patients for reduction of the tibial plateau fracture, and their collapsed articular surfaces were restored by our self-designed universal high affinity prying technique, or by fibular graft support, or by the hooping technique to restore the transverse diameter of the tibial plateau which had been widened. The outcomes of fracture reduction at 2 days postoperation were recorded and evaluated by Rasmussen imaging assessment. Complications were also recorded. The visual analog scale (VAS) pain scores and Hospital for Special Surgery (HSS) scores were compared between preoperation, 3 and 6 months postoperation and the rates of fracture healing between 3 and 6 months postoperation.Results:This group of 66 patients was followed up for 12.0(8.0, 16.5) months. The Rasmussen imaging assessment at 2 days postoperation: 60 excellent, 4 good, and 2 fair cases, yielding an excellent to good rate of 97.0% (64/66). At 3 and 6 months postoperation, the VAS scores [1 (0, 1) and 0 (0, 1)] and HSS scores [84 (78, 88) and 91 (85, 95)] were significantly improved compared with those before operation [4 (3, 5) and 36 (29, 39)], and the values at 6 months postoperation were significantly improved compared with those at 3 months postoperation ( P<0.05). The rate of clinical fracture healing at 6 months postoperation (100%, 66/66) was significantly higher than that at 3 months postoperation (77.3%, 51/66) ( P<0.05). Perioperatively, no adverse events were observed like incision infection, deep vein thrombosis of lower limbs, or failure or exposure of internal fixation, except for delayed incision healing in only one patient. Conclusion:In the minimally invasive surgery for tibial plateau fractures, our modified double reverse traction technique can result in excellent fracture reduction by imaging assessment, fine functional recovery of the knee joint and relief of pain.
RESUMEN
Objective:To evaluate the application of ERAS concept in the treatment of tibial plateau fractures with minimally invasive double reverse tractions (MIDRT).Methods:A retrospective study was conducted of the 39 patients with tibial plateau fracture who had been treated at Department of Orthopedics, Union Hospital from February 2018 to June 2020. They were 20 males and 19 females, aged from 27 to 47 years. All cases were treated with the same MIDRT but with different perioperative management protocols. Of them, 20 received conventional perioperative management (control group) and 19 perioperative ERAS management (ERAS group). The 2 groups was compared in terms of visual analogue scale (VAS) at 24 hours postoperation, drainage volume, time for removal of drainage tube, hospital stay, patient’s satisfaction, incidence of complications, and American Special Surgery Hospital (HSS) scores at discharge and 1, 3, 6 and 9 months postoperation.Results:There was no significant difference in the preoperative general data between the 2 groups, showing comparability between groups ( P>0.05). All cases obtained complete follow-up (mean, 10.9 months). No statistically significant difference was found between the 2 groups in drainage volume, time for removal of drainage tube or HSS scores at discharge or one month after discharge ( P>0.05). The VAS score at 24 hours after operation, hospital stay [(9.4±4.8) d], patient's satisfaction, HSS scores [(90.8±3.8), (93.5±4.3) and (95.6±3.7)] in the ERAS group were significantly better than those in the control group [(13.3±1.9) d, (87.5±5.1), (88.1±4.4) and (88.8±4.4)] ( P<0.05). None of the patients had such serious complications as wound infection, breakage or failure of internal fixation, or fracture nonunion. Conclusion:The perioperative management protocols designed according to the ERAS concept may enhance the clinical efficacy of MIDRT in the treatment of tibial plateau fractures and thus raise the patient’s satisfaction.