| Objective:By retrospective analysis, compare the indication and clinical efficacy of LISS with anatomic plate fixation of two surgical methods for treatment of complex tibial plateau fracture, and provide clinical basis and reference for choosing appropriate surgical method。Methods:select45cases of tibial plateau fractures consistent with the internalizing standards through the computer-based patient record system and Medical Records and Statistics Room, which are cured in the department of Orthopedics in the Second XiangYa Hospital of Central South University from January2011to January2014. Divide the cases into anatomic plate internal fixation group and LISS plate internal fixation group according to the operation method. Collect the imaging features as well as clinical data and follow up data was successfully obtained in outpatient department or by telephone. Get the following information:1. Intraoperative situation:anesthesia, surgical approach, incision size, internal fixation, intraoperative blood loss and operating time.2. Postoperative treatment:whether to use external fixation support, begin time of knee exercise and when to bear load.3. Intertion status: stitches removal time, callus formation time, bone healing time, the scope of the knee joint flexion and extension, Merchant knee functional score.4. Complications:If the patients have complications such as infection, anchylosis, traumatic arthritis, internal fixation loosening or breakage, if they have reoperation not in plan. According to the collected data, process statistical analysis between the two groups in bone healing time, incidences of complications and Merchant knee functional score. Determine whether there are statistically significant and evaluate the clinical curative effect between the two groups.Results:44of the45respondents were reinterviewed, with an average reinterview time Of13.84weeks. In the17cases of LISS plate internal fixation group, the average operation time is2.32hours, the mean length of operative incision is8.82cm, the mean blood loss in operation is226.48ml, the mean blood loss after operation is130.59ml.Postoperative complications include traumatic arthritis in one, no deep infection occurred, no delayed union or nonunion occurred, no loosening or breakage of plates and screw occurred. The complication rate is5.89%.The average clinical healing time is12.71weeks, the mean weight-bearing time is14.94weeks. The knee function with the Merchant standard score in10Patients are rated excellent, the results in4are good, the results in3are rated as fair, the total rate of excellent and good cases is82.35%. In the27cases of anatomic plate internal fixation group, he average operation time is2.84hours, the mean length of operative incision is19.67cm, the mean blood loss in operation is318.52ml, the mean blood loss after operation is197.78ml. Postoperative complications include traumatic arthritis in three, delayed union in one, no deep infection occurred, no loosening or breakage of plates and screw occurred. The complication rate is14.81%.The average clinical healing time is13.74weeks, the mean weight-bearing time is15.74weeks. The knee function with the Merchant standard score in16Patients are rated excellent, the results in6are good, the results in4are rated as fair, and the results in two are rated as poor.the total rate of excellent and good cases is81.84%.In the above parameters, the compare of average operation time, the mean blood loss in and after operation, the mean length of operative incision in two groups is statistically significant different, but there are no significant differences between the two groups in average clinical healing time, mean weight-bearing time or the Merchant standard score.Conclusion:LISS have a significant advantage in shortening the length of operative incision, reducing operation time as well as blood loss in and after operation (P<0.05).The two methods are both excellent in clinical healing time, weight-bearing time and the Merchant standard score. |
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