| Objective :To study the short-term effect of anterior lateral posterolateral medullary double incision approach and anterior median incision double-plate fixation in the treatment of Schatzker Ⅴ-and Ⅵ tibial plateau fractures.Methods::The clinical data of 52 patients admitted to our hospital from Jan.2013 to Jan.2017 in our hospital and diagnosed with complicated tibial plateau fractures and surgically treated were statistically analyzed.All patients underwent imaging and other auxiliary examinations.According to imaging data were Schatzker classification Ⅴ or Ⅵ type,according to the way the patients underwent surgery,the 52 patients were divided into two groups,namely the observation group and the control group.The patients in the observation group were treated by two incisions of anterolateral incision and posteromedial incision.The average time from fracture to operation was 5.5(1-12)days,a total of 28 cases,including 15 males and 13 females For example,their average age was 50 years old(31-70 years old);according to Schatzker classification of Ⅴ type in 18 cases,type Ⅵ in 10 cases;According to the causes of fracture can be divided into height fall injury in 8 cases,car accident injury 12 Cases,fall injury in 6 cases and other causes in 2 cases;according to the type of tibial plateau injury can be divided into open fractures and closed fractures,respectively,4 cases,24 cases;according to the knee associated with injury can be divided into medial collateral ligament injury,Lateralcollateral ligament injury,medial meniscus injury,lateral meniscus injury,anterior cruciate ligament injury and posterior cruciate ligament injury were 5 cases,3 cases,3cases,4 cases,2 cases and 2 cases.Patients in the control group were treated with a single anterior median single-incision approach,with an average of 5.3(1-12)days between fracture and operation for a total of 24 patients,including 14 in males and 10 in females,and their mean age 49 years old(19-69 years old);according to Schatzker classification of Ⅴ type in 11 cases,type Ⅵ in 13 cases;according to the causes of fractures were divided into high fall injuries in 8 cases,car accident injury in 10 cases,fall injury in 4 cases and other;According to the type of tibial plateau injury,there are 2 cases of open fractures and 22 cases of closed fractures.According to the concomitant injury of the knee joint,the medial collateral ligament injury and the lateral collateral ligament injury were divided into two groups.Medial meniscus injury,lateral meniscus injury,anterior cruciate ligament injury and posterior cruciate ligament injury were 4 cases,2 cases,4cases,4 cases,2 cases and 1 case.The study compared operative time,intraoperative bleeding,postoperative drainage volume,intraoperative varus angle,medial platform anteroposterior inclination,lateral platform posterior inclinations,incidence of postoperative complications and postoperative 12 The knee joint function score was used to assess the recovery of knee joint function.Results: There were no significant differences in the age,operation time,intraoperative blood loss,postoperative drainage volume and postoperative tibial plateau varus angle and lateral plateau inclination between the two groups(P> 0.05)The mean value was 15.4 ± 1.0o.The mean lean angle of the medial platform in the control group was 16.1 ± 1.4o,which was significantly higher in the control group than in the observation group.There was significant difference between the two groups(P <0.05).A total of 52 patients in both groups were followed up for an average of 26(12-42)months.All patients received bony union,no skin necrosis and no complications such as fracture healing or malunion.Incision infection occurred in 3 patients in symptomaticgroup and the complication rate was 12.5%.In the observation group,2 patients had incision Infection,the incidence of complications was 7.14%,there was no significant difference between the two groups(P> 0.05).All of the above 5 patients were cured by anti-infective antibiotics.The scores of knee joint function at 12 months after operation were 82.50 ± 6.30 in the observation group,of which 20 were excellent,6 were good,2were fair and 0 were poor.The excellent and good rate was 92.8%.The total score of the control group was 77.45 ± 9.26 points,of which 12 were excellent,5 were good,6fair and 1 poor,the excellent and good rate was 70.8%.The difference between the two groups was statistically significant(P <0.05).Conclusion: The study showed that there was no significant difference between the two groups in age,operation time,blood loss,postoperative drainage,tibial plateau varus angle and lateral platform posterior slope(P> 0.05)There was no significant difference between the two groups in the clinical complication,but the excellent rate of knee joint function score and knee joint function recovery in the two-way approach group was significantly higher than that in the anterior median approach group at 12 months after operation.The differences between the two groups were statistically significant(P <0.05).This study showed that for the Schatzker Ⅴ-type and Ⅵ-type tibial plateau fractures,the approach of anterolateral combined posterior medial double incision was superior to the anterior median incision approach. |
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