Comparison of the effect of anteroposterior medial and lateral knee incision and double plate internal fixation on knee function in patients with complex tibial plateau fractures / 中国基层医药

ABSTRACT

Objective:To compare the effect of double plate internal fixation with medial and lateral knee incision and anterior straight knee incision on the knee function of patients with complex tibial plateau fracture.Methods:From January 2016 to March 2018, 94 patients with complex tibial plateau fractures treated with double plate internal fixation were divided into the control group(straight incision in the middle of the knee) and the observation group(double incisions on the inside and outside of the knee) according to the random digital table method, with 47 cases in each group.The differences of perioperative indicators, posterior tibial plateau inclination angle, varus angle and knee function scores between the two groups were compared.Results:There was no statistically significant difference in intraoperative blood loss between the two groups( P>0.05). The operation time of the observation group[(84.35±11.85)min]was longer than that of the control group[(62.14±10.05)min], the treatment cost of the observation group[(3.28±0.61)ten thousand CNY]was more than that of the control group[(2.08±0.58)ten thousand CNY]( t=9.80, 9.12, all P<0.01). The days of hospitalization, the time of loading and the time of fracture healing in the observation group were (6.78±2.17)d, (44.76±9.33)d, (3.57±1.04)months, which were shorter than those in the control group[(10.24±2.25)d, (55.09±10.25)d, (5.57±1.37)months]( t=7.59, 5.11, 7.97, all P<0.01). There were no statistically significant differences in the posterior inclination angle and varus angle of the tibial plateau between the two groups at 6 months after surgery(all P>0.05). In the control group, the posterior inclination angle and varus angle of the tibial plateau were significantly increased at 12 months after operation compared with 6 months after operation(all P<0.01). There were no statistically significant differences in the posterior inclination angle and varus angle of the tibial plateau in the study group between 12 months after surgery and 6 months after surgery(all P>0.05). At 12 months after operation, the tibial plateau caster angle[(6.49±1.14)°]and the varus angle[(85.17±2.70)°] in the observation group were significantly lower than those in the control group[(8.05±1.55)° and (91.35±2.88)°]( t=5.56, 10.73, all P<0.01). There were no statistically significant differences in the Rasmussen and Harris scales scores of knee joints between 12 months after surgery and 6 months after surgery in the two groups(all P>0.05). The results of Rasmussen scale and Harris scale in the study group were significantly higher than those in the control group(all P<0.01). Conclusion:Compared with the knees straight incision, although knee inside and outside double incision double plate fixation treatment for patients with complex tibial plateau fractures can lead to increased operation time, high cost of treatment, but can shorten in-hospital time, promote the fracture healing after surgery, promote the recovery of the original anatomical structures, which can effectively improve the function of knee joint, thus is worthy of clinical application.