本文選題：脛骨平臺(tái)骨折 + 微創(chuàng)內(nèi)固定系統(tǒng)��； 參考：《中南大學(xué)》2014年碩士論文

【摘要】：目的：通過(guò)回顧性分析,比較LISS和解剖鋼板內(nèi)固定兩種手術(shù)方式治療復(fù)雜脛骨平臺(tái)骨折的適應(yīng)癥及臨床療效,為今后選擇合適手術(shù)方法提供臨床依據(jù)及參考。 方法：利用中南大學(xué)湘雅二醫(yī)院病歷檢索系統(tǒng)及病案科保存的2011年1月至2013年1月明確診斷為脛骨平臺(tái)骨折而且符合本次研究納入標(biāo)準(zhǔn)的45例病例,按照手術(shù)方法分為解剖鋼板內(nèi)固定及LISS鋼板內(nèi)固定組,收集其影像學(xué)及臨床病例資料,通過(guò)電話(huà)及門(mén)診復(fù)診方式進(jìn)行隨診,掌握患者1.術(shù)中情況：麻醉方式,手術(shù)入路,切口大小,內(nèi)固定方式,術(shù)中出血量,手術(shù)時(shí)間2.術(shù)后處理：是否使用外固定支架,何時(shí)開(kāi)始膝關(guān)節(jié)鍛煉,何時(shí)負(fù)重3.愈合情況：傷口情況,拆線時(shí)間,骨痂形成時(shí)間,骨愈合時(shí)間,膝關(guān)節(jié)屈伸范圍,按Merchant標(biāo)準(zhǔn)評(píng)定膝關(guān)節(jié)功能并進(jìn)行統(tǒng)計(jì)學(xué)分析4.并發(fā)癥：是否出現(xiàn)感染、關(guān)節(jié)僵硬、創(chuàng)傷性關(guān)節(jié)炎、骨折不愈合、內(nèi)固定松動(dòng)斷裂等并發(fā)癥,是否有非計(jì)劃再次手術(shù)。根據(jù)所收集資料,著重于術(shù)中指標(biāo)、骨折愈合情況及膝關(guān)節(jié)功能Merchant評(píng)分三方面對(duì)兩者進(jìn)行統(tǒng)計(jì)分析,確定是否有統(tǒng)計(jì)學(xué)差異,判斷二者臨床療效優(yōu)劣,并在各個(gè)方面進(jìn)行細(xì)化比較。 結(jié)果：符合入組條件的45例病例中共44例獲得回訪并完成膝關(guān)節(jié)功能評(píng)價(jià),平均隨訪時(shí)間13.84月。其中,LISS組17例,平均手術(shù)時(shí)間為2.32小時(shí),平均手術(shù)切口長(zhǎng)度為8.82cm,平均術(shù)中出血量為226.48ml,平均術(shù)后引流量為130.59ml,術(shù)后1例創(chuàng)傷性關(guān)節(jié)炎,無(wú)深部感染、骨延遲愈合或者不愈合、內(nèi)固定松動(dòng)或斷裂等發(fā)生,并發(fā)癥發(fā)生率為5.89%,平均骨折愈合時(shí)間為12.71周,平均完全負(fù)重時(shí)間為14.94周,按Merchant標(biāo)準(zhǔn)評(píng)定膝關(guān)節(jié)功能,優(yōu)10例,良4例,中3例,差0例,優(yōu)良率82.35%；解剖鋼板組27例,平均手術(shù)時(shí)間為2.84小時(shí),平均手術(shù)切口長(zhǎng)度為19.67cm,平均術(shù)中出血量為318.52ml,平均術(shù)后引流量為197.78ml,術(shù)后3例創(chuàng)傷性關(guān)節(jié)炎,1例延遲愈合,無(wú)深部感染、內(nèi)固定松動(dòng)或斷裂等發(fā)生,并發(fā)癥發(fā)生率為14.81%,平均骨折愈合時(shí)間為13.74周,平均完全負(fù)重時(shí)間為15.74周,按Merchant標(biāo)準(zhǔn)評(píng)定膝關(guān)節(jié)功能,優(yōu)16例,良6例,中4例,差1例,優(yōu)良率81.84% 兩組患者上述指標(biāo)中,平均手術(shù)時(shí)間、平均手術(shù)切口長(zhǎng)度及平均術(shù)中出血量和術(shù)后引流量差異有統(tǒng)計(jì)學(xué)意義,LISS組均小于解剖鋼板組,并發(fā)癥發(fā)生率、平均骨折愈合時(shí)間、完全負(fù)重時(shí)間和Merchant膝關(guān)節(jié)功能評(píng)分方面差異無(wú)統(tǒng)計(jì)學(xué)意義。 結(jié)論：LISS技術(shù)相對(duì)于解剖鋼板內(nèi)固定術(shù),在縮小患者手術(shù)傷口、減少手術(shù)時(shí)間和術(shù)中術(shù)后出血量方面具有顯著優(yōu)勢(shì)(P0.05)；在術(shù)后并發(fā)癥發(fā)病率,術(shù)后骨折臨床愈合時(shí)間和完全負(fù)重時(shí)間方面,兩者無(wú)明顯差異(P0.05),且膝關(guān)節(jié)功能恢復(fù)方面兩者表現(xiàn)均優(yōu)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.
【學(xué)位授予單位】：中南大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類(lèi)號(hào)】：R687.3

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