Liu Hao, Lin Zhihao, Ma Yueyan, Gong Haifeng, Wang Tianrui, Ye Fagang, Hu Yanling
Department of Trauma Surgery, the Affiliated Hospital of Qingdao University, Qingdao Shandong, 266035, P. R. China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2025 Jul 15;39(7):795-800. doi: 10.7507/1002-1892.202504101.
To compare the effectiveness and advantages of the double reverse traction reduction versus open reduction internal fixation for treating complex tibial plateau fractures.
A clinical data of 25 patients with Schatzker type Ⅴ or Ⅵ tibial plateau fractures, who met the selection criteria and were admitted between January 2019 and January 2023, was retrospectively analyzed. Thirteen patients underwent double reverse traction reduction and internal fixation (double reverse traction group), while 12 patients underwent open reduction and internal fixation (traditional open group). There was no significant difference in the baseline data (age, gender, injury mechanism, Schatzker classification, interval between injury and operation) between the two groups ( >0.05). The effectiveness were evaluated and compared between the two groups, included operation time, intraoperative blood loss, incision length, hospital stay, full weight-bearing time, complications, fracture healing, Rasmussen radiological score (reduction quality), knee Hospital for Special Surgery (HSS) score, and knee flexion/extension range of motion.
The double reverse traction group demonstrated significantly superior outcomes in operation time, intraoperative blood loss, hospital stay, incision length, and time to full weight-bearing ( <0.05). Two patients in traditional open group developed incisional complications, while the double reverse traction group had no complication. There was no significant difference in the incidence of complication between the two groups ( >0.05). All patients were followed up 24-36 months (mean, 30 months), with no significant difference in follow-up duration between groups ( >0.05). Fractures healed in both groups with no significant difference in healing time ( >0.05). At 6 months after operation, Rasmussen radiological scores and grading showed no significant difference between the two groups ( >0.05); the double reverse traction group had significantly higher HSS scores compared to the traditional open group ( <0.05). At 12 months after operation, knee flexion/extension range of motion were significantly greater in the double reverse traction group than in the traditional open group ( <0.05).
Double reverse traction reduction offers advantages over traditional open reduction, including shorter operation time, reduced blood loss, minimized soft tissue trauma, and improved joint functional recovery. It is a safe and reliable method for complex tibial plateau fractures.
比较双反牵引复位与切开复位内固定治疗复杂胫骨平台骨折的有效性及优势。
回顾性分析2019年1月至2023年1月间收治的25例符合入选标准的SchatzkerⅤ型或Ⅵ型胫骨平台骨折患者的临床资料。13例患者接受双反牵引复位内固定（双反牵引组），12例患者接受切开复位内固定（传统切开组）。两组患者的基线资料（年龄、性别、损伤机制、Schatzker分型、受伤至手术间隔时间）比较，差异无统计学意义（>0.05）。对两组患者的手术时间、术中出血量、切口长度、住院时间、完全负重时间、并发症、骨折愈合情况、Rasmussen放射学评分（复位质量）、膝关节特殊外科医院（HSS）评分以及膝关节屈伸活动度等有效性指标进行评估和比较。
双反牵引组在手术时间、术中出血量、住院时间、切口长度及完全负重时间方面均显著优于传统切开组（<0.05）。传统切开组有2例患者出现切口并发症，双反牵引组无并发症发生。两组并发症发生率比较，差异无统计学意义（>0.05）。所有患者均获随访，随访时间24～36个月，平均30个月，两组随访时间比较，差异无统计学意义（>0.05）。两组骨折均愈合，愈合时间比较，差异无统计学意义（>0.05）。术后6个月，两组Rasmussen放射学评分及分级比较，差异无统计学意义（>0.05）；双反牵引组HSS评分显著高于传统切开组（<0.05）。术后12个月，双反牵引组膝关节屈伸活动度显著大于传统切开组（<0.05）。
双反牵引复位较传统切开复位具有手术时间短、出血少、软组织创伤小及关节功能恢复好等优势。是治疗复杂胫骨平台骨折安全可靠的方法。
