一种治疗伴有骨筋膜室综合征的胫骨平台骨折的新方法。

A Novel Approach in the Management of Tibial Plateau Fractures with Compartment Syndrome.

作者信息

Madhuchandra P, Muthukumar Balaji S

机构信息

Department of Orthopaedics, BGS Global Institute of Medical Sciences, Bengaluru, India.

No.757, 5th Main Road, ISRO Layout, Bangalore, Karnataka 560078 India.

出版信息

Indian J Orthop. 2023 Jul 22;57(9):1435-1442. doi: 10.1007/s43465-023-00955-x. eCollection 2023 Sep.

DOI:10.1007/s43465-023-00955-x

PMID:37609025

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10441992/

Abstract

BACKGROUND

Compartment syndrome in tibial plateau fractures presents a formidable challenge for treating orthopedic surgeons. The most common strategy is early fasciotomy and external fixation, followed by a second stage definitive fixation. We conducted a prospective study of tibial plateau fractures of Schatzker Type V and VI with impending compartment syndrome treated by single-stage double incision fasciotomy and dual internal fixation and Vacuum-Assisted Closure (VAC).

MATERIALS AND METHODS

The study was between May 2014 and February 2019. 21 patients with impending compartment syndrome who underwent single-stage double incision fasciotomy and Open Reduction and Internal Fixation (ORIF) with dual plate were included in the study. The functional and radiological outcome was measured using the modified Rasmussen functional and radiological scoring and The Western Ontario and McMaster Universities Arthritis Index (WOMAC).

RESULTS

The mean age of patients was 38.7 years (Standard deviation of ± 9.48). The mean follow-up period was 27 months (Standard deviation of ± 6.51). The mean functional and radiological modified Rasmussen score was 27.28 (range 21 to 29) & 8 (range 7 to 10), respectively. 4 patients had excellent outcomes, and 17 patients had good results. The mean WOMAC score was 8.04 (Standard deviation of ± 5.35). Five patients had a score of 0, 14 patients had a score of 1-10 and 2 had a score of 11-20.

CONCLUSIONS

The early double incision fasciotomy and definitive internal fixation with dual plate and VAC as single-stage surgery in patients with impending compartment syndrome help to obtain excellent to good functional outcomes with reduced complications.

摘要

背景

胫骨平台骨折并发骨筋膜室综合征对骨科医生来说是一项艰巨的挑战。最常见的策略是早期行筋膜切开术和外固定，随后二期进行确定性固定。我们对Schatzker V型和VI型胫骨平台骨折并即将发生骨筋膜室综合征的患者进行了一项前瞻性研究，采用单阶段双切口筋膜切开术、双内固定及封闭负压引流（VAC）治疗。

材料与方法

研究时间为2014年5月至2019年2月。纳入21例即将发生骨筋膜室综合征且接受单阶段双切口筋膜切开术及双钢板切开复位内固定（ORIF）的患者。采用改良的Rasmussen功能和影像学评分以及西安大略和麦克马斯特大学骨关节炎指数（WOMAC）来评估功能和影像学结果。

结果

患者的平均年龄为38.7岁（标准差±9.48）。平均随访时间为27个月（标准差±6.51）。改良Rasmussen功能和影像学评分的平均值分别为27.28（范围21至29）和8（范围7至10）。4例患者结果为优，17例患者结果为良。WOMAC评分的平均值为8.04（标准差±5.35）。5例患者评分为0，14例患者评分为1 - 10，2例患者评分为11 - 20。