Harvard Combined Orthopaedic Residency Program, Boston, MA USA.
Massachusetts General Hospital, Boston, MA USA.
Injury. 2022 Oct;53(10):3475-3480. doi: 10.1016/j.injury.2022.07.037. Epub 2022 Jul 26.
The use of one midline incision versus dual medial/lateral incisions for dual plating of bicondylar tibial plateau (BTP) fractures is controversial. This study aimed to compare rates of infection and secondary surgery in patients treated with dual plating for a BTP fracture using a single versus double incisions.
Retrospective cohort study.
Two Level-1 trauma centers.
PATIENTS/PARTICIPANTS: Patients > 18 years with a closed AO/OTA 41-C BTP fracture without compartment syndrome treated with a single midline or dual incision (lateral with medial or posteromedial) approach for dual plating.
Dual plating through either a single anterior incision, or dual medial/lateral incisions.
Rates of deep infection and reoperation were compared using Chi-square analysis (p-value of < 0.05).
In total 636 AO/OTA 41-C BTP fractures treated between 1/1/01 and 12/31/18 were identified and assessed. After exclusions for limited follow up, other techniques, open fracture and the need for fasciotomies, 346 patients were studied. Of these 254 had been treated with a single plate / single approach technique while 92 had been dual plated, 41 through a single anterior incision while 51 had dual plating through separate lateral and medial or posteromedial incisions. For these 92 fractures, there was no significant difference in the rate of deep infection (22.0% vs 23.5%, s=0.858) or reoperation (31.7% vs 31.4%, p=0.973) between the single and dual incision groups. Injuries that had been treated with single plating via a single incision had comparably lower rates of deep infection (10.2% vs. 22.8%, p=0.003) and reoperation (12.2% vs. 31.5%, p<0.001). There were no significant differences in any demographic parameters between patients undergoing single versus dual plating. Although retrospective, not randomized and subject to single surgeon bias these data suggest that these complications are more based on injury than the approach.
III.
对于双髁胫骨平台（BTP）骨折的双钢板固定，使用单一中线切口与双内侧/外侧切口的效果存在争议。本研究旨在比较使用单切口与双切口治疗 BTP 骨折患者的感染率和二次手术率。
回顾性队列研究。
两个 1 级创伤中心。
患者/参与者：年龄>18 岁的闭合性 AO/OTA 41-C BTP 骨折患者，无筋膜间室综合征，采用单中线或双内侧/外侧切口（外侧加内侧或后内侧）入路行双钢板固定。
通过单一前切口或双内侧/外侧切口进行双钢板固定。
采用卡方分析比较深部感染和再次手术的发生率（p 值<0.05）。
共确定并评估了 2001 年 1 月 1 日至 2018 年 12 月 31 日期间接受治疗的 636 例 AO/OTA 41-C BTP 骨折患者。排除随访时间有限、其他技术、开放性骨折和需要筋膜切开术的患者后，共纳入 346 例患者进行研究。其中 254 例采用单钢板/单入路技术治疗，92 例采用双钢板固定，41 例采用单一前切口，51 例采用单独的外侧和内侧或后内侧切口。对于这 92 例骨折，单切口组与双切口组在深部感染率（22.0% vs 23.5%，s=0.858）或再次手术率（31.7% vs 31.4%，p=0.973）方面无显著差异。通过单切口接受单钢板固定的骨折深部感染率（10.2% vs. 22.8%，p=0.003）和再次手术率（12.2% vs. 31.5%，p<0.001）均较低。接受单钢板与双钢板固定的患者在任何人口统计学参数方面均无显著差异。尽管该研究为回顾性、非随机且存在单外科医生偏倚，但这些数据表明，这些并发症更多地基于损伤类型，而不是手术入路。
III。
