Wang Zhongzheng, Zheng Zhanle, Ye Pengyu, Tian Siyu, Zhu Yanbin, Chen Wei, Hou Zhiyong, Zhang Qi, Zhang Yingze
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.
J Orthop Translat. 2022 Jul 9;36:1-7. doi: 10.1016/j.jot.2022.06.005. eCollection 2022 Sep.
The objective of this study was to compare the clinical and radiological outcomes of two surgical methods for tibial plateau fractures (TPFs): minimally invasive surgery (MIS) using a double reverse traction repositor and traditional open reduction internal fixation (ORIF).
From our prospectively collated database, 187 consecutive adult patients with 189 operatively treated TPFs in our level I trauma center were included from January 2015 to March 2018 who had a minimum of three years' follow-up. All cases were performed by the senior surgeon using either MIS (group 1, 84 patients with 84 TPFs) or ORIF (group 2, 103 patients with 105 TPFs). Details of the demographics, injury mechanism, pre- and postoperative follow-up imaging, operative procedures and complications were collected. The final results from the 36-Item Short-Form Health Survey (SF-36), Western Ontario and McMaster Universities Osteoarthritis index (WOMAC) and Hospital for Special Surgery (HSS) were obtained at the final follow-up.
Clinically, significant differences were observed in the WOMAC (pain, = 0.001; stiffness, < 0.001), HSS ( = 0.003) and SF-36 ( = 0.001). Radiologically, significant intergroup differences were observed in the loss of immediate postoperative reduction rates, secondary loss of reduction rates and signs of osteoarthritis (Kellgren-Lawrence). Two and ten superficial infections in group 1 (2.4%) and group 2 (9.5%), respectively, and 6 lateral popliteal nerve palsy cases occurred (0 MIS, 6 ORIF), with significant intergroup differences.
Our study shows that the MIS using a double reverse traction repositor is promising and safe technique for the TPFs when used for the correct indications.
The current status of using a minimally invasive surgery for the treatment of TPFs have been analyzed and a new method of using a double reverse traction repositor for the treatment of TPFs have been proposed in this study, which updated treatment concept of TPFs.
本研究的目的是比较两种治疗胫骨平台骨折（TPF）的手术方法的临床和影像学结果：使用双反向牵引复位器的微创手术（MIS）和传统的切开复位内固定术（ORIF）。
从我们前瞻性整理的数据库中，纳入了2015年1月至2018年3月在我们一级创伤中心接受手术治疗的189例TPF的187例成年连续患者，这些患者至少随访了三年。所有病例均由资深外科医生采用MIS（第1组，84例患者84例TPF）或ORIF（第2组，103例患者105例TPF）进行。收集了人口统计学、损伤机制、术前和术后随访影像学、手术操作及并发症的详细信息。在最终随访时获得了36项简明健康调查（SF-36）、西安大略和麦克马斯特大学骨关节炎指数（WOMAC）以及特种外科医院（HSS）的最终结果。
临床上，在WOMAC（疼痛，P = 0.001；僵硬，P < 0.001）、HSS（P = 0.003）和SF-36（P = 0.001）方面观察到显著差异。影像学上，在术后即刻复位丢失率、继发性复位丢失率和骨关节炎征象（凯尔格伦-劳伦斯分级）方面观察到显著的组间差异。第1组和第2组分别有2例和10例表浅感染（2.4%和9.5%），并且发生了6例腓总神经麻痹（MIS组0例，ORIF组6例），组间差异显著。
我们的研究表明，当用于正确的适应证时，使用双反向牵引复位器的MIS是一种治疗TPF有前景且安全的技术。
本研究分析了使用微创手术治疗TPF的现状，并提出了一种使用双反向牵引复位器治疗TPF的新方法，更新了TPF的治疗理念。
