| Objective:The cruciate ligament of knee joint is an important structure to maintain the stability of knee joint and ensure the normal function of knee joint.In clinical practice,tibial plateau fractures are often associated with cruciate ligament injuries.In recent years,there have been many reports on the treatment of tibial plateau fracture with cruciate ligament injury.However,most reports are limited to the primary treatment of tibial plateau fracture and cruciate ligament injury,and there are few reports on the secondary treatment of cruciate ligament injury.In this paper,68 cases of tibial plateau fracture combined with cruciate ligament injury were reviewed in several hospitals in Shanxi Province,aiming to observe and analyze the difference between the effect of simultaneous reconstruction and staged reconstruction of tibial plateau fracture combined with cruciate ligament injury.Methods:68 patients(42 males and 26 females)with tibial plateau fracture complicated with acl injury who underwent surgical treatment from April 2014 to September 2017 were selected from the department of orthopedics of the second hospital of shanxi medical university,the department of orthopedics of shanxi people’s hospital,the department of orthopedics of shanxi big hospital,the department of orthopedics of datong third people’s hospital and the department of orthopedics of datong fifth people’s hospital,Department of orthopedics,linfen people’s hospital,Department of orthopedics,yuncheng central hospital.The age ranged from 17 to 71 years old,with an average age of 46.0 years.Causes: traffic accident injury 42 cases(61.8%),fall 19 cases(27.9%),heavy parts in 3patients(4.4%),sports injury in 3 patients(4.4%),beating injury in 1 case(1.5%).According to the Schatzker type,type Ⅰ 11 cases,9 cases Ⅱ type,type Ⅲ 11 cases,14 cases Ⅳ type,Ⅴ type 12 cases,11 cases Ⅵ type.Surgical methods: for the cases treated at the same time,open reduction and internal fixation were performed first,and the acl reconstruction was performed under the knee arthroscope.For patients treated by stage,incision,reduction,bone grafting,plate and screw internal fixation,secondary repair and reconstruction of the acl.Different types of combined soft tissue injury should be treated in time.Postoperative knee function was evaluated by Lysholm knee score.Results:This group of cases is divided into the contemporaneous operation group and the stage operation group.The two groups of patients have no statistical significance(P > 0.05)in respect of age,gender and gender,indicating that the two groups have better homogeneity.All the 68 patients were followed up for 3 to 24 months.All fractures were healed,and no incision infection,loosening or fracture of internal and external fixation were found postoperatively.Lysholm knee score 7 cases in the same period of operation group were evaluated as excellent,30 as good,and 4 as acceptable.Excellent and good rate: 90.24%.The results of 7 patients in the staging operation group were excellent,5were good and 2 were acceptable.Conclusion:1.The staged reconstruction of tibial plateau fracture combined with cruciate ligament injury and the simultaneous reconstruction had a good effect.2.The effect of staged reconstruction of tibial plateau fracture combined with cruciate ligament injury was not as good as that of the concomitant reconstruction group,and there was no difference in the effect between the concomitant reconstruction group and the concomitant reconstruction group.3.For simple Schatzker Ⅰ-Ⅳ tibial plateau fractures should be as much aspossible to give a repair ligament.But for Schatzker Ⅴ,Ⅵ complex comminuted fracture of tibial plateau,a period should be given priority to with fracture fixation.If the cruciate ligament is difficult to be repaired in the first stage,ligament reconstruction can be performed in the second stage after the fracture is healed. |
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