通讯作者: 吴云飞, 849893410@qq.com

DOI：10.12201/bmr.202411.00018

Clinical efficacy observation of the four pillar concept in the treatment of Schatzker type I-IV tibial plateau fractures

• 摘要：目的:探讨胫骨平台骨折治疗领域的四柱理念,通过比较四柱理念与Schatzker分型理念在Ⅰ-Ⅳ型胫骨平台骨折治疗方面的影像学检查结果和临床疗效,评估该理念的有效性和实用性。方法:采用前瞻性队列研究分析,选自在2022年9月1日至2023年4月30日期间,对我院70例胫骨平台骨折患者进行治疗,按照手术方式不同分为治疗组(四柱理念组)和对照组(Schatzker分型理念组),每组各35例。所有患者接受完整的X线和CT三维重建检查,术后进行定期的膝关节X线正侧位片复查。收集了术后1月和术后1年的数据,包括胫骨平台后倾角(Posterior Tibial Slope, PTS)、胫骨平台内翻角(mTPA)、关节面继发移位的测量,以及视觉模拟评分法(VAS)、膝伸屈ROM(°)、Lysholm评分和膝关节功能评分(HSS)。结果显示,手术时间和出血量在两组间存在显著差异(p<0.001),表明治疗组在手术时间和出血量方面优于对照组。切口长度、拆线时间和住院时间的差异无统计学意义(p>0.05)。在PTSA组别、测量次数与组别的交互效应显著(p<0.001),说明PTSA在术后不同时间、不同组下变化有统计学意义。关节面继发塌陷组别的主效应、测量次数及测量次数与组别的交互效应显著(p<0.001),表明关节面继发塌陷术后在不同组的不同时间测量均有统计学意义。mPTA组别的主效应、测量次数及测量次数与组别的交互效应均不显著(p＞0.05),表明mPTA术后在不同组的不同时间测量均无统计学意义。两组患者的VAS评分在术后1年比术后1月显著好转(p<0.001)。ROM(°)、Lysholm评分的主效应、测量次数及测量次数与组别的交互效应显著(p<0.001),说明ROM(°)、Lysholm评分术后在不同组的不同时间测量均有统计学意义。HSS评分的主效应显著(p<0.001),表明HSS评分术后在不同组的不同时间测量均有统计学意义,但无交互意义。结论:四柱理念基于对胫骨平台的4个损伤机制、四柱分型、4个手术入路的考量,同时引入“主要问题骨柱”和软组织对角线原理,指导手术次序和内固定原则,能有效恢复骨折端对位对线和固定强度,改善膝关节活动度。因此四柱理念指导下的手术治疗SchatzkerⅠ-Ⅳ型胫骨平台骨折具有良好的临床疗效,值得在临床中推广应用。

  关键词： 四柱理念；Schatzker分型；胫骨平台骨折; ; 

   

  Abstract: Objective: To explore the four pillar concept in the treatment of tibial plateau fractures, compare the imaging examination results and clinical efficacy of the four pillar concept and Schatzker classification concept in the treatment of type I-IV tibial plateau fractures, and evaluate the effectiveness and practicality of this concept. Method: A prospective cohort study was conducted to analyze 70 patients with tibial plateau fractures treated in our hospital from September 1, 2022 to April 30, 2023. They were divided into a treatment group (four column concept group) and a control group (Schatzker classification concept group) according to different surgical methods, with 35 patients in each group. All patients undergo complete X-ray and CT three-dimensional reconstruction examinations, and undergo regular knee joint X-ray anteroposterior and lateral radiograph follow-up after surgery. We collected data at 1 month and 1 year after surgery, including measurements of Posterior Tibial Slope (PTS), Tibial Plateau Inverted Angle (mTPA), secondary displacement of the articular surface, as well as Visual Analog Scale (VAS), Knee Flexion ROM (°), Lysholm Score, and Knee Joint Function Score (HSS). The results showed a significant difference in surgical time and bleeding volume between the two groups (p<0.001), indicating that the treatment group was superior to the control group in terms of surgical time and bleeding volume. There was no statistically significant difference in incision length, suture removal time, and hospitalization time (p>0.05). The interaction effect between the PTSA group, measurement frequency, and group was significant (p<0.001), indicating that there were statistically significant changes in PTSA at different times and in different groups after surgery. The main effect, measurement frequency, and interaction effect between measurement frequency and group were significant (p<0.001) in the group with secondary articular surface collapse, indicating that there were statistically significant measurements at different times in different groups after surgery for secondary articular surface collapse. The main effect, measurement frequency, and interaction effect between the mPTA group and the group were not significant (p>0.05), indicating that there was no statistical significance in the measurement of mPTA at different times in different groups after surgery. The VAS scores of both groups of patients showed significant improvement at 1 year after surgery compared to 1 month after surgery (p<0.001). The main effect, measurement frequency, and interaction effect between ROM (°) and Lysholm score and group were significant (p<0.001), indicating that ROM (°) and Lysholm score were statistically significant at different time points in different groups after surgery. The main effect of HSS score was significant (p<0.001), indicating that HSS score was statistically significant at different time points in different groups after surgery, but there was no interactive significance. Conclusion: The four pillar concept is based on the consideration of four injury mechanisms, four pillar classification, and four surgical approaches of the tibial plateau. At the same time, it introduces the main problem bone pillar and soft tissue diagonal principle to guide the surgical sequence and internal fixation principles. It can effectively restore the alignment and fixation strength of the fracture end, and improve the range of motion of the knee joint. Therefore, the surgical treatment of Schatzker type I-IV tibial plateau fractures guided by the four pillar concept has good clinical efficacy and is worthy of promotion and application in clinical practice.

  Key words: four-column classification system; Schatzker typing; tibial plateau fracture

  提交时间：2024-11-09

  版权声明：作者本人独立拥有该论文的版权，预印本系统仅拥有论文的永久保存权利。任何人未经允许不得重复使用。
• html

• 图表

• 朱敏, 汤样华. 肌肉能量技术在踝关节骨折术后康复中的疗效观察. 2024. doi: 10.12201/bmr.202409.00014

  金宇梦, 李亚平. 调神养心汤治疗心肾不交型围绝经期失眠的临床观察. 2024. doi: 10.12201/bmr.202408.00031

  杨庆松, 张燕洁, 刘燕, 刘振. 加味散偏汤治疗肝郁血瘀型紧张型头痛临床观察. 2024. doi: 10.12201/bmr.202412.00019

  李森强, 冯琦, 宋才渊, 李伦辛. 张氏清热消瘀汤联合VSD治疗胫腓骨开放性骨折创面感染疗效及安全性. 2024. doi: 10.12201/bmr.202410.00023

  伍静, 杨青. 清肝宁心制动方治疗儿童注意缺陷多动障碍心肝火旺型的临床观察. 2024. doi: 10.12201/bmr.202412.00051

  王昕. 杨志宏治疗肝阳上亢型高血压性眩晕的临床经验. 2020. doi: 10.12201/bmr.202004.00008

  许林敏, 陈新艳, 郭芳, 李玮, 陈海棠. 单孔腹腔镜术在卵巢囊肿治疗中的疗效观察. 2024. doi: 10.12201/bmr.202410.00071

  思小霞, 赵青, 景江新. 超声影像组学在预测乳腺癌分子分型中的应用进展. 2024. doi: 10.12201/bmr.202410.00040

  陈丕楠, 谢诗桐, 贺小宁, 杨智豪, 吴晶. EQ-HWB量表健康状态分级系统构建述评与经验启示. 2023. doi: 10.12201/bmr.202301.00002

  魏贤振, 王海云, 丁以山, 陈朝蔚. 电针手法治疗膝骨关节炎的临床疗效-价值分析. 2024. doi: 10.12201/bmr.202412.00030

• 序号	提交日期	编号	操作
  1	2024-08-29	bmr.202411.00018V1	下载

• 公开评论  匿名评论  仅发给作者 提交评论