| ObjectiveTo evaluate the clinical efficacy and risk factors of combining approach with three plates internal fixation for tibial plateau fracture of three columns.MethodAccording to the"three-column theory",the fracture types of patients were three-column fractures.According to the Schatzker classification:31 cases of V type and 19 cases of type VI,50 patients meet the above criteria were randomly divided into observational group(28)and conventional group(22).The observation group was treated with anterior anterolateral combined with posterior lateral approach L three plates internal fixation,and the conventional group was treated with anterolateral lateral approach posterior medial approach dual plate internal fixation.Surgical treatment was based on the principle of complete anatomical reduction,strong internal fixation and early postoperative joint function exercise.The operative time and intraoperative blood loss was observed and recorded in the two groups;It was followed up at the immediate time,3 months,and 12 months after operation,And then,compared with knee exercise time,clinical healing time,and Weight-loading time between the two groups.To analysis the X-ray film’s posterior dip(PA)and varus angle(TPA)comparatively at the immediate time,3 months and 12 months postoperatively,and to analysis of the knee joint HSS score at 12 months after surgery.Finally,according to factors such as gender,cause of injury,combined injuries around the knee,postoperative complications and postoperative rehabilitation exercises,it was discussed by the risk factors affecting the surgical restoration effect of tibial plateau fracture.ResultsAll 50 patients were followed up for 13 to 38 months with an average of 18.7months.The statistical analysis was performed on the operation time and blood loss between the control group and the observation group.The difference was statistically significant(P<0.05).The knee joint functional exercise was statistically analyzed between the two groups,the difference was statistically significant(P<0.05).There was no statistically significant difference in PA and TPA between the two groups immediately after surgery,3 months after surgery,and 12 months after surgery(P>0.05).The PA of 12 months after surgery was analyzed between groups,and the difference was statistically significant(P<0.05).According to knee function scores,the excellent and good rates at 12 months were 93.10%and 77.27%in the observation and control group,respectively,and the x~2 value was 3.927.P=0.048,the difference was statistically significant(P<0.05).Logistic multivariate regression analysis showed that knee joint injury and postoperative complications were the effect of surgical reduction of tibial plateau fracture(P<0.05).Conclusions:Combined treatment with three plate internal fixation for the treatment of three-column fractures could better achieve a strong internal fixation,more early to exercise,less postoperative complication.At the same time,combined injuries around the knee and postoperative complications are independent risk factors that influencing the surgical reduction of tibial plateau fracture and can guide clinical practice. |
