《膝关节镜下有限切开骨折复位内固定术治疗胫骨平台骨折的疗效及对血清NGF、sVCAM和ALP水平的影响.docx》由会员分享,可在线阅读,更多相关《膝关节镜下有限切开骨折复位内固定术治疗胫骨平台骨折的疗效及对血清NGF、sVCAM和ALP水平的影响.docx(6页珍藏版)》请在优知文库上搜索。
1、膝关节镜下有限切开骨折复位内固定术治疗胫骨平台骨折的疗效及对血清NGF、SVCAM和ALP水平的影响何鹏马拓*杜俊伟王斌石海浪西电集团医院骨科陕西西安710077通讯作者:马拓0I摘要旧的研究膝关节镜F有限切开骨折复位内固定术治疗胫骨平台骨折的疗效及对血清神经生长因子(NGF)、血管细胞黏附因子(SVCAM)、碱性磷酸酶(ALP)水平的影响.方法选择2019年2月至2020年2月我院60例胫骨平台骨折患者进行研究。按照随机数表法分为研究组和对照组各30例,对照组采用传统切开复位内固定术治疗,研究组采用膝关节镜下有限切开骨折复位内固定术治疗。比较两组治疗3个月后治疗优良率,术后恢复情况(手术切口
2、长度、骨折愈合时间、关节活动度),治疗前及治疗3个月后Rasmussen和VAS评分、血清NGF、SVCAM和ALP水平,记录分析两组住院期间的并发症发生率。结果研究组的治疗优良率为86.66%,明显高于对照组的60.00%,差异有统计学意义(P0.05);研究组手术切口长度、骨折愈合时间分别为(5.811.23)cm、(3.10+0.52)月,均明显短于对照组的(19.023.61)cm、(5.89+0.71)月,研完组的关节活动度为(126.75+15.62)。,明显高于对照组的(118.6313.29)0,差异有统计学意义(P0.05):研究组Rasmussen评分为(95.036.87
3、)分,明显高于对照组的(82.65+4.32)分,差异具有统计学意义(PV0.05);研究组VAS评分为(3.09052)分,明显低于对照组的(5.611.03)分,差异具有统计学意义(P0.05);研究组NGF、ALP水平分别为(l.360.32)mg/L、(275.86+60.32)U/L,均明显高于对照组的(0.890.27)mg/L、(190.7647.69)U/L,差异有统计学意义(P0.05)i研究组并发症发生率为3.33%,明显低于对照组23.33%,差异有统计学意义(P0.05。结论膝关节镜下有限切开骨折复位内固定术治疗胫骨平台骨折的疗效显著,可促进骨愈合,减轻炎症反应,降低术
4、后并发症,利于术后早期功能锻炼。【关健词】膝关节镜F:有限切开骨折复位内固定术;胫骨平台骨折;炎症反应:并发症TheeffectoflimitedincisionfracturereductionandinternalfixationunderarthroscopyontibialplateaufractureandtheinfluenceonserumNGF,sVCAMandALPlevelsHepengmatuo*dujunweiwangbinshihailangDepartmentofOrthopedics,XidianHospitalShanxiXi,an710077AbstractO
5、bjectiveTostudytheeffectoflimitedincisionfracturereductionandinternalfixationunderarthroscopyontibialplateaufractureandtheinfluenceonserumNGF,sVCAMandALPlevels.Methods60patientswithtibialplateaufracturewhoreceivedtreatmentinourhospitalfromFebruary2018toFebruary2020wereselectedforthisstudy,Theywerera
6、ndomlydividedintostudygroupandcontrolgroupwith30casesineachgroup.Thecontrolgroupwastreatedwithtraditionalopenreductionandinternalfixation,Thestudygroupwastreatedwithlimitedopenreductionandinternalfixationunderkneearthroscoe.Theexcellentrate,postoperativerecovery(incisionlength,fracturehealingtime,jo
7、intactivity)werecomparedinthetwogroupsafter3months,andtheRasmussenandVASscores,serumNGF,sVCAMandALPlevelswerecomparedbeforeandafter3months,theincidenceofcomplicationsinthetwogroupsduringhospitalizationwasrecordedandanalyzed.ResultsTheexcellentandgoodrateofthestudygroupwas86.66%,whichwassignificantly
8、higherthanthatofthecontrolgroup60.00,thedifferencewasstatisticallysignificant(P0.05);thelengthofincisionandfracturehealingtimeofthestudygroupwere(5.811.23)cm,(3.100.52)month,whichwassignificantlyshorterthanthatofthecontrolgroup(19.023.61)cm,(5.890.71)month,therangeofmotionofthestudygroupwas(126.7515
9、.62)o,whichwassignificantlyhigherthanthatofthecontrolgroup(l18.6313.29),thedifferencewasstatisticallysignificant(P0.05);therasmussenscoreofthestudygroupwas(95.036.87)scores,whichwassignificantlyhigherthanthatofthecontrolgroup(82.654.32)scores,thedifferencewasstatisticallysignificant(P0.05);theVASsco
10、reofthestudygroupwas(3.090.52)scoreswassignificantlyshorterthanthatofthecontrolgroup(5.611.03)scores,thedifferencewasstatisticallysignificant(P0.05)thelevelsofNGFandALPinthestudygroupWere(1.360.32)mgL,(275.8660.32)UL,wassignificantlyhigherthanthatofthecontrolgroup(0.890.27)mgL,(190.7647.69)UL,thedif
11、ferencewasstatisticallysignificant(P0.05)theincidenceofcomplicationsinthestudygroupwas3.33%,whichwassignificantlylowerthanthatofthecontrolgroup23.33%,thedifferencewasstatisticallysignificant(P。本研究经伦理委员会批准,患者均知情同意。1.2 方法对照组采用传统切开复位内固定术治疗,(1)于术中翻起皮下组织和皮肤,切开关节囊,若发现半月板己出现损伤,则视损伤情况决定是否保留;(2)随后切开半月板冠状韧带,掀
12、起半月板,将胫骨平台关节面充分暴露,翘起已经塌陷的关节面,将胫骨踝骨块和塌陷的关节面保持在同一平面上;(3)采用C型臂X线机观察骨折端复位情况研究组采用膝关节镜F有限切开骨折复位内固定术治疗,(1)采用膝关节镜检查患者的关节软骨和半月板损伤情况;(2)随后缝合或切除半月板,对Il型患者先进行塌陷处理,于塌陷的关节面下23cm处做ICmXICm骨窗,将骨膜剥离至关节面平整,固定采用克氏针,采用C型臂X线机观察复位情况,在其下方的骨缺损处采用自体韶骨进行植入修复,后恢复关节平面,固定采用空心螺钉;(3)对In型患者采用探钩勾起半月板,将干萌端软组织剥离迁入,于骨折塌陷处23cm处做2cmx2cm骨窗,推顶复位方法同II型,后平整关节面,固定采用支撑钢板。1.3 观察指标观察两组治疗优良率,术后恢复情况(手术切口长度、骨折愈合时间、关节活动度),膝关节功能和视觉模拟评分法(VAS)评分,NGF、SVCAM和ALP水平变化,并发症发生率。分别于两组治疗前后采用RaSmUSSen