Efficacy comparison between modified two-window and conventional single-window posteromedial inverted L-shaped approach for reduction and internal fixation of flexion-inversion tibial plateau fractures
10.3760/cma.j.cn501098-20240329-00251
- VernacularTitle:改良双窗与传统单窗膝关节后内侧倒“L”形入路复位内固定治疗屈曲内翻型胫骨平台骨折的疗效比较
- Author:
Zhiyuan LIU
1
;
Weibo ZHOU
;
Jianfeng HUANG
;
Wei CHEN
;
Fulin ZHOU
Author Information
1. 常州市武进人民医院骨科，常州 213017
- Keywords:
Tibial fractures;
Fracture fixation, internal;
Surgical approach
- From:
Chinese Journal of Trauma
2024;40(9):793-800
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To compare the efficacy of reduction and internal fixation of flexion-inversion tibial plateau fractures with a modified two-window and conventional single-window posteromedial inverted L-shaped approach.Methods:A retrospective cohort study was used to analyze the clinical data of 44 patients with flexion-inversion tibial plateau fractures admitted to the Affiliated Changzhou No.2 People′s Hospital of Nanjing Medical University from January 2018 to December 2022, including 22 males and 22 females, aged 31-58 years [(44.4±9.1)years]. Among them, 25 patients were injured on the left side and 19 on the right. A total of 23 patients were treated with the conventional single-window posteromedial inverted L-shaped approach (conventional single-window approach group), while the other 21 with the modified two-window posteromedial inverted L-shaped approach (modified two-window approach group). The length of surgical incision, operation time, intraoperative blood loss, postoperative drainage volume, and postoperative hospital stay were compared between the two groups. The articular step-offs, medial tibial plateau angles (mTPA), tibial posterior slope angles (PSA), and Rasmussen radiological scores at 3 days, 3 months after surgery and at the last follow-up were evaluated in the two groups. The visual analogue scale (VAS) scores before surgery, at 7 days and 3 months after surgery, data of extension-flexion motion of the knee joint at 7 days after surgery and Hospital for Special Surgery (HSS) knee function scores at 3 and 6 months after surgery and at the last follow-up were compared between the two groups. At the last follow-up, the fracture healing was observed. The postoperative incidence of complications such as thrombosis and poor wound healing was compared between the two groups.Results:All the patients were followed up for 12-18 months [(15.7±3.2)months]. The operation time of the modified two-window approach group was (121.6±19.2)minutes, significantly shorter than (149.5±22.4)minutes of the conventional single-window approach group ( P<0.01). There were no statistically significant differences in the length of surgical incision, intraoperative blood loss, postoperative drainage volume, or postoperative hospital stay between the two groups ( P>0.05). At 3 days, 3 months after surgery and at the last follow-up, the articular step-offs of the modified two-window approach group were 0.7(0.5, 0.9)mm, 1.0(0.8, 1.1)mm and 0.9(0.8, 1.0)mm respectively, significantly shorter than 1.0(0.7, 1.2)mm, 1.1(1.0, 1.3)mm and 1.1(0.9, 1.2)mm of the conventional single-window approach group ( P<0.05 or 0.01); the mTPA of the modified two-window approach group was 87.0(86.0, 87.0)°, 87.0(86.0, 87.0)° and 86.0(85.5, 87.0)° respectively, significantly larger than 85.0(84.0, 86.0)°, 85.0(84.0, 86.0)°and 85.0(84.0, 86.0)°of the conventional single-window approach group ( P<0.01); the Rasmussen radiological scores of the modified two-window approach group were (17.0±0.9)points, 16.0(15.0, 17.0)points and 16.0(15.0, 16.0)points respectively, significantly higher than (16.4±1.1)points, 13.0(13.0, 15.0)points and 14.0(13.0, 15.0)points of the conventional single-window approach group ( P<0.05 or 0.01); no significant differences in the PSA were found between the two groups ( P>0.05). There were no significant differences in VAS scores between the two groups before surgery and at 3 months after surgery ( P>0.05), while the VAS score at 7 days after surgery was 3.0(3.0, 3.0)points in the modified two-window approach group, significantly lower than 3.0(3.0, 4.0)points of the conventional single-window approach group ( P<0.05). There was no significant difference in the VAS score at 3 months after surgery between the two groups ( P>0.05). The extension-flexion motion of the knee joint at 7 days after surgery was 90.0(85.0, 95.0)° in the modified two-window approach group, higher than 80.0(75.0, 85.0)° of the conventional single-window approach group ( P<0.01). The HSS knee function score at 3 months after surgery was (67.9±2.8)points in the modified two-window approach group, higher than (66.1±2.7)points of the conventional one-window approach group ( P<0.05). There were no significant differences in the HSS knee function scores at 6 months after surgery and at the last follow-up between the two groups ( P>0.05). At the last follow-up, bone union was observed in both groups. One patient in the conventional single-window approach group developed partial popliteal vein thrombosis, with a complication rate of 4.4% (1/23); while one patient in the modified two-window approach group had poor healing of the incision postoperatively, with a complication rate of 4.8%(1/21) ( P>0.05). Conclusion:Compared with the conventional single-window approach, the modified two-window posteromedial inverted L-shaped approach has the advantages of shorter operation time, better reduction quality, early pain relief, and better restoration of knee joint extension-flexion motion and joint function in the reduction and internal fixation of flexion-inversion tibial plateau fractures.
