Comparative Analysis Of The Efficacy Of Combined Approach Treble With Plate Or Double Plate Internal Fixation For Tibial Plateau Fracture Of Three Columns

PURPOSE:To study the clinical efficacy of treble plate and double plate for the treatment of tibial plateau fracture of three columns,and evaluate the therapeutic effect of the two methods for the treatment of tibial plateau fracture of three columns.METHODS:Choose the patiens with tibial plateau fracture of three columns from August 1,2014 to January 31,2016,whose meet the screening criteria.All the patients were treated in our department of orthopedics.The screening condition was closed fracture,one knee,the diagnosis was clear(excluding the other heart,lung,liver,kidney,blood,immune and other medical diseases and mental disorders),a total of 68 cases.There were 28 cases(group A)treated with the combined approach of treble plate,and 40 cases(group B)were treated by combined approach of double plate.The group A were treated with the approach of anterolateral and posterior reversed L that with the fixation of treble plate,while the group B were the approach of anterolateral Posteromedial.Before the operation,all the laboratory and imaging examinations were carried out,and the preoperative consultation and consultation were carried out to make sufficient preoperative preparation.The operation time,blood loss,average length of stay,postoperative complications,fracture healing time,and full weight-bearing time were compared between the two groups.The knee varus angle(TPA)and posterior tilt angle(PSA)and 12 months after operation,and the HSS knee score and SF-36 score were measured at the first and t 12 th month after operation,to evaluate the postoperative recovery of knee function.The above data usingstatistical data analysis software SPSS 22 for statistical analysis,to make comprehensive evaluation of the efficacy of the two groups.RESULTS:All patients were followed up in the two groups,no one was absence of follow-up.The number of follow-up months ranged from 12~30 months,with an average follow-up period of 16.9 months.The operation time of group A was(99.3 + 12)min,which group B was(91.8 + 10)min,P=0.006,the difference was statistically significant;12 months after operation,SF-36 score of group A is(81 + 6.2),and group B was(74.6 + 6.9),(P=0.000 < 0.05),the difference was statistically significant.According to the HSS knee function score,the excellent and good rates of group A and B were 89.3% and76.5%,respectively,The Chi square test results: x2 value 4.345,p=0.037< 0.05,Chi square test results: x2 value 4.345,p=0.037 < 0.05,and there were significant differences in the excellent and good rate of knee joint function between the two groups.The degree of knee joint after 12 months of operation,the group A was 2~122° and,and group B was 2~119°,which was slightly larger than the degree of group B.The injured knee tibial plateau between Immediately after operation and 12 months after operation,the PSA of group B were(10.35 + 2.31)°and(11.13 + 2.43)°,t=-4.466,P=0.000,the difference was statistically significant.CONCLUSION :For complex fracture of tibial plateau,especially the three columns fracture,strong fixation of the fracture of each column with a combination approach of treble plate,which compared with the treatment of treble column fracture combined with the treatment of double plate,it can be used for better anatomic reduction and rigid fixation of the fracture block,which can be more effective for postoperative rehabilitation exercise.The complicationwas not increased,but its effect was more accurate.The fixation of the posterior column complex fractures,taking the back side of the L approach has a better advantage.