Chen Mingli, Chen Zonglin, Li Honghan, Chen Jinhong, Gao Hongpeng, Huang Miao, Xue Guanqi, Lin Zepeng, Yang Rongyuan
Department of Orthopedics, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou Fujian, 363000, P. R. China.
School of Clinical Medicine, Fujian Medical University, Fuzhou Fujian, 350004, P. R. China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2024 Jul 15;38(7):830-835. doi: 10.7507/1002-1892.202404004.
To investigate the effectiveness of the reverse traction device in the preoperative treatment of high-energy tibial plateau fractures.
A retrospective study was conducted to analyze the clinical data of 33 patients with high-energy tibial plateau fractures who met the selection criteria between December 2020 and December 2023. All patients were treated by open reduction and internal fixation. According to the preoperative traction method, they were divided into the observation group (16 cases, treated with a reverse traction device on the day of admission) and the control group (17 cases, treated with heel traction on the day of admission). There was no significant difference in baseline data such as gender, age, body mass index, affected side, cause of injury, fracture Schatzker classification between the two groups ( >0.05). Preoperative waiting time, preoperative related complications (nail channel loosening, nail channel oozing, nail channel infection, soft tissue necrosis, soft tissue infection, deep vein thrombosis of the lower extremity, ), operation time, and total hospitalization time were recorded and compared between the two groups. On the 4th day after traction, visual analogue scale (VAS) score was used to evaluate the pain relief of the patients, the swelling value of the affected limb was measured, and the Immobilization Comfort Questionnaire (ICQ) score was used to evaluate the perioperative hospital comfort of the patients.
Both groups of patients completed the operation successfully, and the operation time, total hospitalization time, and preoperative waiting time of the observation group were significantly less than those of the control group ( <0.05). There was no preoperative related complications in the observation group; in the control group, 3 patients had nail channel loosening and oozing, and 2 cases had the deep vein thrombosis of the lower extremity; the difference in the incidence of complication between the two groups was significant ( <0.05). On the 4th day after traction, the ICQ score, VAS score, and limb swelling value of the observation group were significantly better than those of the control group ( <0.05). X-ray films showed that the tibial plateau fracture separation and lower limb alignment recovered after calcaneal traction in the control group, but not as obvious as in the observation group. The fracture gap in the observation group significantly reduced, the tibial plateau alignment was good, and the lateral angulation deformity was corrected.
The use of reverse traction treatment in patients with high-energy tibial plateau fractures on admission can accelerate the swelling around the soft tissues to subside, reduce patients' pain, shorten the preoperative waiting time, improve the patients' preoperative quality of life, and contribute to the shortening of the operation time, with a good effectiveness.
探讨反向牵引装置在高能胫骨平台骨折术前治疗中的有效性。
进行一项回顾性研究，分析2020年12月至2023年12月期间符合入选标准的33例高能胫骨平台骨折患者的临床资料。所有患者均接受切开复位内固定治疗。根据术前牵引方法，将其分为观察组（16例，入院当天采用反向牵引装置治疗）和对照组（17例，入院当天采用跟骨牵引治疗）。两组患者的性别、年龄、体重指数、患侧、受伤原因、骨折Schatzker分型等基线资料比较，差异无统计学意义（>0.05）。记录并比较两组患者的术前等待时间、术前相关并发症（钉道松动、钉道渗血、钉道感染、软组织坏死、软组织感染、下肢深静脉血栓形成）、手术时间及总住院时间。牵引后第4天，采用视觉模拟评分法（VAS）评估患者疼痛缓解情况，测量患肢肿胀值，采用固定舒适度问卷（ICQ）评分评估患者围手术期住院舒适度。
两组患者均顺利完成手术，观察组患者的手术时间、总住院时间及术前等待时间均明显短于对照组（<0.05）。观察组术前无相关并发症发生；对照组有3例患者出现钉道松动及渗血，2例出现下肢深静脉血栓形成；两组并发症发生率比较，差异有统计学意义（<0.05）。牵引后第4天，观察组患者的ICQ评分、VAS评分及肢体肿胀值均明显优于对照组（<0.05）。X线片显示，对照组跟骨牵引后胫骨平台骨折分离及下肢力线恢复，但不如观察组明显。观察组骨折间隙明显缩小，胫骨平台力线良好，外侧成角畸形得到纠正。
高能胫骨平台骨折患者入院时采用反向牵引治疗，可加速软组织周围肿胀消退，减轻患者疼痛，缩短术前等待时间，提高患者术前生活质量，有助于缩短手术时间，疗效良好。
