The Treatment And Curative Effect Of Overextended Fracture Of Tibial Plateau Fracture

PURPOSE:Through the analysis of hyperextension injuries morphological characteristics of tibial plateau fracture type and its damage mechanism,formulate reasonable treatment plan,and after using the medial anterolateral approach to pour L approach combined treatment of complex fractures,fracture injury condition and postoperative knee function condition,evaluation of clinical curative effect.Materials and methods:TO select the fellowship at jilin university hospital from June 2015-January 2018,included 231 patients of 242 cases of tibial plateau fractures,in line with the "hyperextension injury type fracture of tibial plateau" characteristics of 25 patients(about 10.3%).Among them,15 were male and 10 were female.One knee,23 cases,two knees;Age 25-70,average 45 years old,mostly middle-aged and young;Cause of injury: 14 cases of motor vehicle injury,6 cases of falling injuries,5 cases of falling injuries.They are all fresh closed fractures within 7 days of injury,and exclude other diseases such as heart,liver,lung,kidney,blood and other medical systems,as well as those with mental disorders.Before the operation,the laboratory examination and imagingexamination of the patient's system were performed,and some patients with poor physical condition were brought to the relevant department for consultation and corresponding treatment.According to the fracture morphology characteristics and damage mechanism of different patients,with reference to imaging examination results,assess the patient's soft tissue and nerve,blood vessels and ligament damage,making treatment plan.,because of the selected patients without open injury of important vascular injury and bone fascia room syndrome patients need emergency operation,restore vascular continuity,temporary holding fracture,external fixator,after waiting for soft tissue condition to improve any surgery.For soft tissue with obvious swelling in the knee joint top drawer is the root of bone traction 7 to 14 days,parallel,detumescence treatment for soft tissue recovery enough time and the stability of the fracture,completes the detailed preoperative preparation.According to preoperative scheduled treatment,choose appropriate surgical approach(group used more closed down after L approach anterolateral approach to the joint),internal fixation apparatus and fixed method(selection of tibia platform for reattachment ahead,distal radius "L" type steel exhaust),treatment of ligament and meniscus which shall be determined according to the situation.The duration of operation was recorded andthe amount of bleeding was recorded.After operation,X ray and CT(3D)were used to evaluate the reduction and fixation of fractures.Postoperative follow-up was performed to observe the complications,and the patients' fracture healing status and healing time were recorded through X-ray film,and the total load time of the patients was recorded.The tibia Angle(FTA),tibial plateau(TPA)and tibial plateau(PA)were measured immediately after operation and 12 months after operation.The knee joint activity was recorded 12 months after surgery,and the New York special hospital score(HSS)was performed12 months after surgery.Data processing and analysis were performed using statistical data analysis software SPSS17.0(IBM,USA)to evaluate the efficacy of the operation.Results:All patients had smooth operation,and the operation time was2.0-4.0 hours,with an average of 2.9 hours.Intraoperative blood loss was200-400 ml,and individual patients were treated with allogeneic blood transfusion.Postoperative X-ray and CT(3D)showed that the fracture reduction was satisfactory and the internal fixation was reliable.All patients were followed up for 12-18 months,with an average follow-up period of 14.9 months.In two cases,the incision was nothealed after surgery,and yellow seepage was found in the dressing,and fat droplets were attached to the fluid.In consideration of the damage of the soft tissue at that time,fat liquefaction was caused,and the wound was healed after the treatment of antibiotics and prophylactic antibiotics.The remaining patients healed well.No postoperative infection,no necrosis of skin,no lower limb deep venous thrombosis and other complications occurred.All patients had no internal fixation and no knee instability.Follow-up,all patients were osseous healing,osseous healing time 3 to 6 months,an average of 4.6 months,six months after patients turn to abandon weight-bearing walking,all patients did not appear limp,stairs difficult,soft legs,and so on and so forth.There was no statistically significant difference in TPA,PA,and FTA in the 12 months after surgery(P BBB 0.05).12 months after knee joint mobility,buckling,90-90 °,hyperextension 0-5 °.After 12 months,HSS score was 65-95,with an average score of 89.5.In addition,HSS > 85 is superior,70 < HSS is less than 85,and the optimal rate of this group is 88%.Conclusion:1.The posterior medial inverted L approach combined with the anterolateral approach for the treatment of this type of tibial plateaufracture can provide open operation field and provide wide operating space;the distal radius "L" plate is used and the tibial plateau is fixed in front of the tibial plateau.It can provide the stability of the fracture and the strong support of the articular surface.The clinical effect is satisfactory.2.The research of the damage mechanism can help doctors better distinguish the morphological characteristics of fractures and predict the damage of soft tissue to develop the surgical plan.