| 关节镜下与切开复位内固定手术治疗胫骨平台Schatzker Ⅲ型骨折血清炎症因子变化对预后的影响 |
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投稿时间：2019-01-09
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| 作者 | Author | 单位 | Address | E-Mail |
| 陈刚 |
CHEN Gang |
台州市立医院骨科 台州学院医学院附属医院, 浙江 台州 318000 |
Department of Orthopaedics, Taizhou Municipal Hospital Affiliated Hospital of Taizhou University Medicine School, Taizhou 318000, Zhejiang, China |
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| 郑文标 |
ZHENG Wen-biao |
台州市立医院骨科 台州学院医学院附属医院, 浙江 台州 318000 |
Department of Orthopaedics, Taizhou Municipal Hospital Affiliated Hospital of Taizhou University Medicine School, Taizhou 318000, Zhejiang, China |
tzslyymrlove@163.com |
| 陈滔 |
CHEN Tao |
台州市立医院骨科 台州学院医学院附属医院, 浙江 台州 318000 |
Department of Orthopaedics, Taizhou Municipal Hospital Affiliated Hospital of Taizhou University Medicine School, Taizhou 318000, Zhejiang, China |
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| 黄杨 |
HUANG Yang |
台州市立医院骨科 台州学院医学院附属医院, 浙江 台州 318000 |
Department of Orthopaedics, Taizhou Municipal Hospital Affiliated Hospital of Taizhou University Medicine School, Taizhou 318000, Zhejiang, China |
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| 阮建伟 |
RUAN Jian-wei |
台州市立医院骨科 台州学院医学院附属医院, 浙江 台州 318000 |
Department of Orthopaedics, Taizhou Municipal Hospital Affiliated Hospital of Taizhou University Medicine School, Taizhou 318000, Zhejiang, China |
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| 期刊信息：《中国骨伤》2020年，第33卷，第3期，第252-256页 |
| DOI：10.12200/j.issn.1003-0034.2020.03.013 |
| 基金项目: |
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中文摘要:
目的：探讨关节镜下与切开内固定手术治疗胫骨平台骨折Schatzker Ⅲ型骨折血清炎症因子变化对预后的影响。
方法：回顾性分析2013年11月至2016年11月治疗的30例胫骨平台Schatzker Ⅲ型骨折患者的临床资料，根据手术方式不同分为微创组和对照组，每组15例。微创组采用关节镜下内固定治疗，男8例，女7例；年龄20~50（35.0±14.6）岁；受伤至手术时间7~15（11.0±4.1）d。对照组采用开放手术内固定治疗，男7例，女8例；年龄18~48（33.0±13.6）岁；受伤至手术时间6~14（10.0±3.4）d。比较两组患者手术时间、切口长度、失血量、术后负重时间和骨折愈合时间，分别于术后3 d、6及12个月时检查血清炎症因子IL-1β、IL-6、TNF-α水平；观察术后并发症情况；术后6、12个月采用Lysholm膝关节功能评分进行临床疗效评价。
结果：两组患者均获得随访，两组随访时间比较差异无统计学意义（P>0.05）。微创组手术时间、切口长度、术中出血量、术后负重时间、骨折愈合时间及并发症发生例数分别为（80.3±9.7）min、（4.2±1.0）cm、（102.2±26.4）ml、（30.0±10.0）d、（70.0±5.0）d、0例，对照组分别为（90.3±9.1）min、（10.5±1.1）cm、（221.1±46.8）ml、（50.0±15.0）d、（90.0±6.0）d、2例；两组比较差异有统计学意义（P<0.05）。术后6个月微创组Lysholm评分89.2±5.1高于对照组80.1±3.1；术后6个月微创组Lysholm评分中肿胀、下蹲、疼痛评分高于与对照组（P<0.05）；术后12个月两组Lysholm各单项评分及总分比较差异无统计学意义（P>0.05）。术后3 d、6个月时微创组血清炎症因子IL-1β、IL-6、TNF-α分别为[（52.1±20.1）pg/L、（0.9±0.1）pg/L]，[（56.1±20.1）pg/L、（1.1±1.3）pg/L]，[（28.3±2.5）pg/L、（8.4±1.5）pg/L]，对照组分别为[（64.8±9.1）pg/L、（8.1±2.1）pg/L]，[（65.8±12.3）pg/L、（9.1±5.3）pg/L]，[（38.5±2.3）pg/L、（26.5±1.4）pg/L]；两组各时间点比较差异有统计学意义（P<0.05）。两组术后12个月IL-1β、IL-6、TNF-α比较差异无统计学意义（P>0.05）。术后3 d炎症因子IL-1β[OR=1.279，95%CI（1.047，1.512），P<0.05]，IL-6[OR=1.687，95%CI（1.478，1.888），P<0.05]，TFN-α[OR=2.096，95%CI（1.863，2.316），P<0.05]水平是术后6个月Lysholm评分的独立危险因素。
结论：关节镜下与开放手术内固定治疗胫骨平台Schatzker Ⅲ型骨折均可获得良好的治疗效果。微创组能够缩短手术时间，减少术中失血量，创伤更小，减轻术后炎症反应，降低术后并发症发生率，能够更快地恢复患者的膝关节功能。 |
| 【关键词】关节镜 骨折固定术 胫骨骨折 炎症介导素类 |
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| Effect of changes of inflammatory factors on prognosis of tibia plateau Schatzker Ⅲ fractures treated under arthroscopic or open reduction and internal fixation |
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ABSTRACT
Objective: To explore changes of inflammatory factors on prognosis of tibia plateau Schatzker Ⅲ fractures treated under arthroscopic or open reduction and internal fixation.
Methods: From November 2013 to November 2016,clinical data of 30 patients with tibia plateau Schatzker Ⅲ fractures were retrospectively analyzed,and divided into minimally invasive group and control group according to different surgical methods 15 patients in each group. Minimally invasive group were treated by arthroscopic internal fixation,including 8 males and 7 females,aged from 20 to 50 years old with an average of(35.0±14.6) years old,the time from injury to operation ranged from 7 to 15 days with an average of(11.0±4.1) days. Control group were treated by open reduction and internal fixation,including 7 males and 8 females,aged from 18 to 48 years old with an average of (33.0±13.6) years old,the time from injury to operation ranged from 6 to 14 days with an average of (10.0±3.4) days. Operation time,length of incision,blood loss,postoperative loading time and fracture healing time,complications were compared between two groups. Level of IL-1β,IL-6,TNF-α were detected at 3 days,6 months and 12 months after operation,Lysholm knee function score at 6 and 12 months were compared between two groups.
Results: All patients were followed up,but there was no significant difference in following-up between two groups. Operation time,length of incision,blood loss, postoperative loading time,fracture healing time and cases of complications in minimally invasive group were(80.3±9.7) min,(4.2±1.0) cm,(102.2±26.4) ml,(30.0±10.0) d,(70.0±5.0) d and 0 case respectively;while in control group were(90.3±9.1) min,(10.5±1.1) cm,(221.1±46.8) ml,(50.0±15.0) d,(90.0±6.0) d and 2 cases respectively;there were significant difference between two groups. Lysholm score in minimally invasive group 89.2±5.1 was higher than that of control group 80.1±3.1;and score of swelling,squat and pain in minimally invasive group was higher than that of control group at 6 months after opertaion. While there were no significant difference in each items and total score of Lysholm score between two groups at 12 months after operation. Level of IL-1β,IL-6,and TNF-α in minimally invasive group at 3 days and 6 months were[(52.1±20.1) pg/L,(0.9±0.1) pg/L],[(56.1±20.1) pg/L,(1.1±1.3) pg/L] and[(28.3±2.5) pg/L,(8.4±1.5) pg/L] respectively;while in control group were[(64.8±9.1) pg/L,(8.1±2.1) pg/L],[(65.8±12.3) pg/L,(9.1±5.3) pg/L] and[(38.5±2.3) pg/L,(26.5±1.4) pg/L] respectively;there were statistically difference in level IL-1β,IL-6 and TNF-α between two groups at 3 days and 6 months after operation;while there was no difference at 12 months after operation(P>0.05). Inflammatory cytokines level at 3 days after operation IL-1β[OR=1.279,95%CI(1.047,1.512),P<0.05],IL-6[OR=1.687,95%CI(1.478,1.888),P<0.05],TFN-α[OR=2.096,95%CI(1.863,2.316),P<0.05] was an independent risk factor for Lysholm knee function score at 6 months after operation.
Conclusion: Arthroscopic surgery and open surgery also could obtain good clinical effects in treating tibia plateau Schatzker Ⅲ fractures. Arthroscopic internal fixation could shorten operation time,lessen the mount of blooding with minimally invasive,lower occurrence of postoperative complications,faster recovery of knee function. |
| KEY WORDS Arthroscopy Fracture fixation Tibia fractures Inflammation mediators |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 陈刚,郑文标,陈滔,黄杨,阮建伟.关节镜下与切开复位内固定手术治疗胫骨平台Schatzker Ⅲ型骨折血清炎症因子变化对预后的影响[J].中国骨伤,2020,33(3):252~256 |
| 英文格式: | CHEN Gang,ZHENG Wen-biao,CHEN Tao,HUANG Yang,RUAN Jian-wei.Effect of changes of inflammatory factors on prognosis of tibia plateau Schatzker Ⅲ fractures treated under arthroscopic or open reduction and internal fixation[J].zhongguo gu shang / China J Orthop Trauma ,2020,33(3):252~256 |
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