| Objective:To compare and analyze the role of bilateral locking screw system and contralateral cortical locking screw system in osteoporotic tibial plateau fractures,and to provide strong clinical evidence for promoting the use of contralateral cortical locking screw system in osteoporotic tibial plateau fractures.Methods:A retrospective analysis was made on 62 cases of osteoporotic tibial plateau fractures with complete medical records from May2014 to May 2018 in the Affiliated Hospital of Traditional Chinese Medicine of Southwest Medical University.All of them were closed fractures.32 cases were treated with contralateral cortical locking screw and Weigao plate internal fixation(group A:contralateral cortical locking group);30 cases were treated with bilateral locking screw and Weigao plate internal fixation(group B:bilateral locking screw and Weigao plate internal fixation).Fixed screw group.Two groups of patients were operated by the same senior deputy chief physician in the undergraduate department as the main knife,the same operation team for surgery,the same team for perioperative management.All data and forms,under the guidance and explanation of investigators,are filled out by patients themselves.If patients can not fill in,they are completed by graduate students with clinical medical background who have undergone strict scientific research training for more than two years in the undergraduate department.Data are input by double-entry method,and data statistics are carried out by specialists,who are responsible for follow-up of patients,including the follow-up of two groups of patients.Whether or not to fall off,follow-up time,etc.The sex ratio,age,preoperative time,injury cause analysis,preoperative Schaker classification,operation time,intraoperative bleeding volume,postoperative drainage,intraoperative bone grafting,tibial plateau obliquity,femoral and tibial angle and varus angle,fracture healing time,knee HSS score and postoperative complications were observed and recorded.Statistical software SPSS22.00 was used for statistical analysis.Relative number was used to describe the HSS score of knee joint and other counting data.Fisher’s exact probability method or chi-square test of paired quadruple tables were used for the test.The operation time,intraoperative bleeding volume and postoperative drainage volume were described by mean(+standard deviation).The t-test was used to compare the two groups.When P<0.05,there were significant statistical differences.Results:In the contralateral cortical locking group,32 cases were followed up satisfactorily.No case was lost.The shortest follow-up time was 12 months and the longest was 25 months.The average follow-up time was(15.78±2.45)months.In the bilateral locking screw group,30 patients were followed up satisfactorily.The shortest follow-up time was 13 months and the longest follow-up time was 26 months.The average follow-up time was(15.45±2.33)months.In the contralateral cortical locking group,there were 14 males and 18 females;in the bilateral locking screw group,there were 13 males and 17 females.There was no significant difference in sex ratio between the two groups(X2=1.358,P>0.05).The age of contralateral cortical locking group was 58-80 years old with an average age of(73.54±5.67).The age of bilateral locking screw group was 59-80 years old with an average age of(73.78±5.45).There was no significant difference between the two groups(t=0.257,P>0.05).The average preoperative time of contralateral cortical locking group was(11.21±2.43)days,while that of bilateral locking screw group was(11.56±2.87)days.There was no significant difference in preoperative time between the two groups(t=-0.984,P>0.05).Of the 32patients in the contralateral cortical locking group,11 were injured by car accident and 21 by falling from high place;of the 30 patients in the bilateral locking screw group,10 were injured by car accident and 20 were injured by falling from high place.There was no significant difference in the causes of injury between the two groups(X~2=1.021,P>0.05).Among the 32 patients in the contralateral cortical locking group,there were 11 Schaker II patients,12Schaker III patients and 9 Schaker IV patients in the contralateral cortical locking group,while there were 10 Schaker II patients,11 Schaker III patients and 9 Schaker IV patients in the bilateral locking screw group.There was no significant difference in the preoperative Schaker classification between the two groups(F=2.154,P>0.05).The average preoperative bone mineral density of32 patients in contralateral cortical locking group was(0.385±0.004),while that of bilateral locking screw group was(0.387±0.005).Statistical analysis showed that there was no significant difference in preoperative bone mineral density between the two groups(t=0.154,P>0.05).Among 32 patients in contralateral cortical locking group,the average operation time was(2.33±0.47)h,while that in bilateral locking screw group was(2.56±0.51)h Statistical analysis showed that there was no significant difference in the average operation time between the two groups(t=1.574,P>0.05).Among 32 patients in contralateral cortical locking group,the average intraoperative bleeding volume was(257.87±30.49)ml,while that in bilateral locking screw group was(261.74±30.58)ml.Statistical analysis showed that there was no significant difference in the average intraoperative bleeding volume between the two groups(t=1.195,P>0.05).Among the 32 patients in contralateral cortical locking group,the average drainage volume was(107.21±11.74)ml,while that in bilateral locking screw group was(106.65±11.33)ml.Statistical analysis showed that there was no significant difference in the average drainage volume between the two groups(t=1.987,P>0.05).Of the 32 patients in the contralateral cortical locking group,27 were bone graft patients and 5 were non-bone graft patients.Of the30 patients in the bilateral locking screw group,26 were bone graft patients and4 were non-bone graft patients.There was no significant difference in bone graft between the two groups(X~2=1.871,P>0.05).Three days after operation,DR showed that there was no significant difference in tibial plateau retroversion,femoral-tibial angle and varus angle between the two groups(P>0.05).After one year of follow-up,it was found that the tibial plateau retroversion,femoral-tibial angle and varus angle in contralateral cortical locking group were significantly better than those in bilateral locking screw group(P<0.05).There was no significant difference between contralateral cortical locking group and conventional bilateral locking screw group in the secondary collapse height of tibial plateau articular surface and the number of cases during the follow-up period of 3 days and 1 month after operation.During the follow-up of 6 months and 1 year after operation,the height collapse of tibial plateau articular surface in contralateral cortical locking group was significantly lower than that in conventional bilateral locking screw group(t=6.321,P<0.05;t=7.214,P<0.05),and the number of cases of tibial plateau articular surface collapse in contralateral cortical locking group was also significantly lower than that in conventional bilateral locking screw group(X~2=6.547,P<0.05;X~2=7.006,P<0.05).The average fracture healing time of 32 patients in contralateral cortical locking group was(11.26±2.65)weeks,while that of bilateral locking screw group was(16.32±2.54)weeks.There was a significant difference in fracture healing time between the two groups(t=7.364,P<0.05).Among the 32patients in contralateral cortical locking group,the HSS scores of knee joint in the last follow-up were 21 cases,9 cases,2 cases and 0 cases,respectively.The excellent and good rate was 93.75%.In bilateral locking screw group,10 cases,12 cases,6 cases and 2 cases were excellent and good,the excellent and good rate was 73.33%.There were significant differences in HSS scores between the two groups(X~2=9.254,P<0.05).)In the contralateral cortical locking group,only one patient had traumatic arthritis of knee joint,and the incidence of complications was only 3.16%.In the bilateral locking screw group,one patient had internal fixation loosening/fracture,two patients had fracture nonunion/delayed union,and two patients had traumatic arthritis of knee joint.The incidence of complications was as high as 20.00%.The incidence of postoperative complications between the two groups was compared,and the difference was statistically significant(P<0.05).Conclusion:1.Contralateral cortical locking screw internal fixation system can promote fracture healing and early recovery for functional exercise.2.The contralateral cortical locking screw internal fixation system has obvious advantages in the treatment of osteoporotic tibial plateau fractures. |
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