Efficacy Analysis Of Complex Tibial Plateau Fractures Through Combined Operative Approaches

Developed transport and the increasingly crowded roads will bring more traffic accidents, including the tibial plateau fracture(TPF). TPF is an intra-articular fracture, how to straighten the knee when the violent impact of knee joint, lateral, which makes the joint moment, Most of the time, The inside and outside of the knee joint unbend violent impact when the knee extension, So that the joint appears serious deformity^valgus momently, At the same time, because the knee joint is arranged at the upper end of the hard femur condyle, The impact is bound to cause the tibial cancellous bone consists of a platform and lateral collapse fracture, High energy injury resulted in severe tibial shift, the articular surface is severely damaged, and with different degree of soft tissue contusion, mostly with meniscus and ligament injury, this is called fracture of TPF on the clinical. However, for the treatment of complex tibial plateau fracture is always a difficult problem, the wrong methods of diagnostic and therapeutic will bring serious deformity and impairment of joint function.Objective:To investigate and evaluate the surgical treatment and its results of complex tibial plateau fractures through combined operative approaches.Methods:from February2010-February2013, review of38cases of complex tibial plateau fractures of open reduction and internal fixation in Affiliated Hospital of Binzhou Medical College, According to the method of the operation is divided into the treatment group with combined operative approaches (group A) and the treatment group with the anterior median incision (group B),20cases in group A, group B of18cases, SPSS12.0software package was used for statistical processing, the operation time, incision length, fracture healing time (month), HSS score (points), knee joint motion (ROM) of two groups were statistically analyzed to evaluate the effect of operations.Results:Group A was followed up from11to14months (mean13.2months); group B was followed up from12to14months (mean13.3months). After operations, the two groups were finally healed well, no complications such as nerve, vascular injury. However, group A had shorter operation time than group B, At6months, the HSS score and the range of motion of group A were significantly greater than those of the group B (P<0.05). The X-ray films showed bony union in2groups. The fracture healing time of group A was shorter than that of group B, but no significant difference was found (P>0.05). Group A was followed up from11to14months (mean13.2months); group B was followed up from12to14months (mean13.3months). After operations, the two groups were finally healed well, no complications such as nerve, vascular injury. However, group A had shorter operation time than group B, At6months, the HSS score and the range of motion of group A were significantly greater than those of the group B (P<0.05). The X-ray films showed bony union in2groups. The fracture healing time of group A was shorter than that of group B, but no significant difference was found (P>0.05).No complications occurred in A group, and X-ray of the immediate postoperative showed that anatomical restoration of bones in20cases. During the follow-up period, there were no complications, such as delayed healing, wound infection, breakage of internal fixation. Full weight-bearing time after the operation was4.5-5.5months. Knee flexion133°-114°, knee extension1.0°-2.2°after12months. No complications occurred in group B, but the edge of skin necrosis is2cases, and1cases of superficial infection, finally healed after wound debridement, strengthen dressing change, without internal fixation and bone exposure;1cases of posterior column fracture of tibial plateau fracture of three columns block failed to anatomic reduction,9weeks premature under the full weight-bearing walking, posterior tibial condylar fracture displacement occurred about0.8cm, there were no lower limb deep vein thrombosis. There was significant difference in the incidence of complications between2groups (χ2=6.623, P=0.015).Conclusion:The combined operative approach of complex tibial plateau fractures reduced the complication of soft-tissue injury, which is conductive to reduction of articular surface. Plates provide a sufficient internal fixation. It can permit early motion of knee joint. Therefore, combined operative approaches are an effective surgical approach of treatment of the complex tibial plateau fractures.