Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People's Republic of China.
Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, 050051, People's Republic of China.
Int Orthop. 2022 May;46(5):1133-1143. doi: 10.1007/s00264-022-05324-1. Epub 2022 Feb 2.
The quality and durability of fracture reduction play an important role in the functional prognosis of articulation. The purpose of this study was to investigate the radiological and clinical effects of compression bolts in the treatment of Schatzker I-IV tibial plateau fractures (TPFs).
Between May 2015 and April 2018, a total of 96 consecutive adult patients with operatively treated Schatzker I-IV TPFs were included and divided into two groups according to the internal fixations: Group 1 (unilateral locking plate) and Group 2 (unilateral locking plate combined with compression bolt). Data on demographic and fracture characteristics, postoperative follow-up imaging, intraoperative indicators, postoperative reduction quality and durability, clinical outcomes, and complications were retrospectively collected and compared between the two groups.
There were no significant intergroup differences in preoperative baseline data, duration of operation, intra-operative blood loss, days in hospital, rate of immediate post-operative reduction loss, or complications. The time of fracture healing, the rate of secondary reduction loss, and the mean WOMAC score were significantly reduced compared with those in Group 1 (P = 0.024, 0.015, and 0.024, respectively). There were significant intergroup differences in the mean HSS score (89.0 ± 11.4 vs. 94.4 ± 6.7, P = 0.042), the mean Lysholm score (83.8 ± 9.6 vs. 88.4 ± 5.2, P = 0.027), and the mean SF-36 score (82.8 ± 12.5 vs. 90.5 ± 7.6, P = 0.001). Additionally, there were similar significant differences in subgroup analysis (only included patients with Schatzker II-III), except for WOMAC score.
Compared with unilateral locking plate fixation, unilateral locking plate combined with compressing bolt fixation can reduce the rate of secondary reduction loss, accelerate fracture healing, and show better clinical outcomes for patients with Schatzker I-IV TPFs.
骨折复位的质量和稳定性对关节功能预后起着重要作用。本研究旨在探讨压缩螺栓治疗 Schatzker I-IV 胫骨平台骨折(TPF)的放射学和临床疗效。
2015 年 5 月至 2018 年 4 月,共纳入 96 例成人手术治疗的 Schatzker I-IV TPF 患者,根据内固定方式分为两组:组 1(单侧锁定钢板)和组 2(单侧锁定钢板联合压缩螺栓)。回顾性收集并比较两组患者的人口统计学和骨折特征、术后随访影像学、术中指标、术后复位质量和稳定性、临床结果和并发症等数据。
两组患者术前基线数据、手术时间、术中出血量、住院天数、术后即刻复位丢失率和并发症发生率无统计学差异。与组 1 相比,组 2 的骨折愈合时间、继发性复位丢失率和平均 WOMAC 评分显著降低(P=0.024、0.015 和 0.024)。组 2 的平均 HSS 评分(89.0±11.4 分比 94.4±6.7 分,P=0.042)、平均 Lysholm 评分(83.8±9.6 分比 88.4±5.2 分,P=0.027)和平均 SF-36 评分(82.8±12.5 分比 90.5±7.6 分,P=0.001)均有显著差异。亚组分析(仅纳入 Schatzker II-III 型患者)也有类似的显著差异,除了 WOMAC 评分。
与单侧锁定钢板固定相比,单侧锁定钢板联合压缩螺栓固定可降低继发性复位丢失率,加速骨折愈合,并为 Schatzker I-IV TPF 患者带来更好的临床疗效。