| Objective :(1)To explore the clinical efficacy of Hoffmann external fixator and internal fixation in the treatment of severe tibial plateau fracture in stages;(2)To explore the changes in the quality of life after the use of Hoffmann external fixator and internal fixation in the treatment of severe tibial plateau fracture in stages.Methods:Combined with the research design and exclusion criteria,a retrospective analysis in January 2014-November 2018 in qinghai university hospital orthopaedic trauma surgery were 60 cases of severe complicated fractures of tibial plateau(Schatzker type points: ?,?)in patients with clinical data,including 27 cases ? type,type ? 33 cases.According to the operation method is divided into two groups: group A for Hoffmann external fixator with the internal fixation treatment stage(namely the ? period propped open fixed Hoffmann external fixator,1 to 2 weeks after ? switch to open reduction and internal fixation treatment group),27 cases;Group B was the traditional open reduction and internal fixation group,with 33 cases.Open reduction and internal fixation operation time,blood loss,hospitalization time,incision infection,bone nonunion,and HSS score were compared and analyzed.At the same time,30 health care workers who were randomly selected to study in the graduate school of our hospital without the above diseases and mental and neurological diseases were selected as the control group to analyze the quality of life of patients in group A and group B,with no statistically significant difference in age and gender(P > 0.05),and SF-36 score was compared and analyzed.Results: All the 60 patients were followed up for 6 ~ 18 months,an average of 12 months.(1)27 patients in group A underwent open reduction and internal fixation for(85.22±7.55)min,intraoperative blood loss(125.07±10.63)ml,and hospital stay(11.41±2.04)d.According to HSS knee scoring criteria,15 cases were excellent,8 cases good and 4 cases medium,with an excellent and good rate of 85.18%.(2)Compared with group B,the operative time,blood loss and hospitalization time of open reduction and internal fixation in group A were all lower than those in group B,and the difference was statistically significant(P < 0.05).There was no significant difference in postoperative knee function scores between group A and group B(P > 0.05).There was no difference in the incidence of bone nonunion between group A and group B(P > 0.05),but the incidence of incision infection in group A was lower than that in group B,and the difference was statistically significant(P < 0.05).(3)Both the physiological and mental health scores of the patients in the two groups and the control group in the SF-36 concise health survey scale were decreased(especially the physiological health scores),indicating that the quality of life of the patients in the two groups was decreased to different degrees compared with the healthy population(P < 0.05).There was no significant difference between group A and group B(P > 0.05)in the decline of mental health scores,and the decrease of physiological health scores in group A was less than that in group B,especially in physical pain and vitality(P < 0.05).Conclusion :(1)The staged treatment of severe tibial plateau fracture with Hoffmann external fixator and internal fixator has a definite effect,which is more in line with the concept of injury control and rapid rehabilitation,with a good prognosis and satisfactory recovery of knee joint function.It is an effective method for the treatment of severe and complex tibial plateau fracture.(2)Patients treated with Hoffmann external fixator and internal fixation in stages showed a decline in quality of life compared with normal people,mainly manifested in a decline in physiological health score;However,compared with the traditional open reduction and internal fixation,the Hoffmann external fixator and internal fixation staging had less impact on the postoperative physiological health dimension score of patients with severe tibial plateau fracture. |
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