复杂型胫骨平台骨折合并骨筋膜室 综合征手术方式的选择

Surgical procedure selection of complex tibial plateau fracture with osteofascial compartment syndrome

摘要:

目的 探讨复杂型胫骨平台骨折合并骨筋膜室综合征（OCS）手术方式的选择。方法 回顾性 分析2016 年3 月—2018 年3 月在武警海警总队医院治疗的56 例复杂胫骨平台骨折合并OCS 患者的临床资 料。根据治疗方法的不同分为筋膜室减压后同期内固定组（A 组25 例）和筋膜室减压后二期内固定组（B 组 31 例）。术后随访24 个月，比较两组围手术期情况、关节功能Lysholm 评分、欧洲五维健康量表（EQ-5D） 评分及并发症发生情况。结果 与B 组比较，A 组手术时间缩短、术中出血量减少、住院时间缩短、住院费 用减少（P <0.05）。两组骨折愈合时间比较，差异无统计学意义（P >0.05）。A 组与B 组术前及术后3、6、 12 和24 个月的Lysholm 评分、EQ-5D 评分比较，在不同时间和变化趋势上有差异（P <0.05），不同组间无 差异（P >0.05）。随访期间，两组并发症发生率比较，差异无统计学意义（P >0.05）。结论 筋膜室减压后同 期内固定与二期内固定治疗复杂型胫骨平台骨折合并OCS 的临床效果均令人满意，对肢体尚未出现明显缺血 症状的患者可采用筋膜室减压后同期内固定治疗；而对肢体出现严重缺血症状，短时间内难以完成骨折一期 复位的患者，采用筋膜室减压后二期内固定治疗更为合适。临床医生应该严格把握适应证，根据患者具体情 况选择合适的术式。

Abstract:

Objective To investigate the surgical procedure selection of complicated tibial plateau fracture with osteofascial compartment syndrome (OCS). Methods The clinical data of 56 cases of complex tibial plateau fracture with OCS treated in our hospital from March 2016 to March 2018 were analyzed retrospectively. According to different treatment methods, the patients were divided into group A (one-stage internal fixation after decompression of osteofascial compartment, n =25) and group B (two-stage internal fixation after decompression of osteofascial compartment, n =31). The patients were followed up for 24 months. The perioperative condition, Lysholm score of joint function, EQ-5D score of quality of life and complications were compared between the two groups. Results Compared with group B, group A had shorter operation time (P < 0.05), less intraoperative bleeding (P < 0.05), shorter hospitalization time (P < 0.05), and lower hospitalization cost (P < 0.05). There was no significant difference in fracture healing time between the two groups (P > 0.05). The Lysholm score and EQ- 5D score of group A and group B before and 3, 6, 12 and 24 months after operation were compared, and were found significantly different at distinct time points (P < 0.05). Though Lysholm score and EQ-5D score were not different between the two groups (P > 0.05), the changing trend of Lysholm score and EQ-5D score of the two groups was different (P < 0.05). During the follow-up, there was no significant difference in the incidence of complications between the two groups (P > 0.05). Conclusions The clinical efficacy of one-stage internal fixation and two-stage internal fixation for complex tibial plateau fracture with OCS after decompression of osteofascial compartment is satisfactory. For patients without obvious ischemic symptoms in the limbs, one-stage internal fixation can be carried out at the same time after decompression of osteofascial compartment. For patients with severe ischemic symptoms in the limbs, second-stage internal fixation is more suitable. Thus, appropriate surgical procedures should be selected according to the indications and specific situation of patients.