内固定术联合外固定支架治疗复杂胫骨平台骨折患者的效果及对应激反应的影响研究

黄礼忠

【摘要】 目的：分析内固定术联合外固定支架治疗复杂胫骨平台骨折患者的效果及对应激反应的影响。方法：选取2017年1月-2020年5月本院收治的150例复杂胫骨平台骨折患者，按照掷硬币法将其分为观察组（n=77）和对照组（n=73）。对照组采用双侧支持钢板内固定术治疗，观察组采用内固定术联合外固定支架治疗。比较两组围术期情况、术后6个月膝关节功能恢复情况以及并发症发生情况;比较两组术前和术后7 d机体应激反应指标（SP、PGE2、NPY）以及炎症因子（CRP、IL-1β、IL-8和TNF-α）水平。结果：观察组手术时间、住院时间、骨折愈合时间均短于对照组，术中出血量少于对照组，差异均有统计学意义（P<0.05）。观察组膝关节恢复优良率为94.81%高于对照组的80.82%，差异有统计学意义（P<0.05）。术前，两组SP、PGE2、NPY、CRP、IL-1β、IL-8和TNF-α水平比较，差异均无统计学意义（P>0.05）;术后7 d，两组SP、PGE2、NPY、CRP、IL-1β、IL-8和TNF-α水平均高于术前，但观察组均低于对照组，差异均有统计学意义（P<0.05）。Pearson相关分析法显示，疼痛应激反应指标（SP、PGE2、NPY）与炎症因子（CRP、IL-1β、IL-8、TNF-α）均呈正相关（P<0.05）。两组并发症发生率比较，差异有统计学意义（P<0.05）。结论：内固定术联合外固定支架治疗复杂胫骨平台骨折具有术后疼痛小、恢复快、机体应激反应小、并发症少等優点，更有利于患者膝关节功能的恢复，临床上值得推广。

【关键词】 内固定术 外固定支架 胫骨平台骨折 应激反应

Study on the Effect of Internal Fixation Combined with External Fixation Stent in the Treatment of Patients with Complex Tibial Plateau Fractures and Its Influence of Stress Response/HUANG Lizhong. //Medical Innovation of China， 2021， 18（32）： 0-052

[Abstract] Objective： To analyze the effect of internal fixation combined with external fixation stent in the treatment of patients with complex tibial plateau fracture and its influence of stress response. Method： A total of 150 patients with complex tibial plateau fractures admitted to our hospital from January 2017 to May 2020 were selected， they were divided into observation group （n=77） and control group （n=73） according to coin tossing method. The control group was treated with bilateral support plate internal fixation， and the observation group was treated with internal fixation combined with external fixation stent. The perioperative period indexes， the recovery of knee function， 6 months after surgery and the incidence of complications were compared between two groups. Stress response indexes （SP， PGE2， NPY） and inflammatory factors （CRP， IL-1β， IL-8， TNF-α） before and 7 d after surgery were compared between two groups. Result： The surgical time， hospital stay and fracture healing time of the observation group were shorter than those of the control group， and the intraoperative blood loss was less than that of the control group， the differences were statistically significant （P<0.05）. The recovery of knee function excellent and good rate of observation group was 94.81%， which was higher than 80.82% in control group， the difference was statistically significant （P<0.05）. Before surgery， there were no significant differences in SP， PGE2， NPY， CRP， IL-1β， IL-8 and TNF-α levels between two groups （P>0.05）; 7 d after surgery， the levels of SP， PGE2， NPY， CRP， IL-1β， IL-8 and TNF-α of both groups were higher than those before surgery， while those of the observation group were lower than those of the control group， the differences were statistically significant （P<0.05）. Pearson correlation analysis showed that the indexes of pain stress response （SP， PGE2， NPY） were positively correlated with the levels of inflammatory factors （CRP， IL-1β， IL-8 and TNF-α） （P<0.05）. There was significant difference in the incidence of complications between two groups （P<0.05）. Conclusion： Internal fixation combined with external fixation stent in the treatment of complex tibial plateau fractures has the advantages of less postoperative pain， faster recovery， less stress response and fewer complications， which is more conducive to the recovery of knee joint function， which is worthy of promotion in clinic.

[Key words] Internal fixation External fixation stent Tibial plateau fracture Stress response

First-author’s address： Jian’ou Municipal Hospital， Jian’ou 353100， China

doi：10.3969/j.issn.1674-4985.2021.32.012

胫骨平台骨折是指由于内外翻暴力导致的关节内骨折，是临床上常见的骨折类型之一[1]。复杂型胫骨平台骨折常常合并严重的软组织、韧带以及血管神经的损伤，如未及时救治，可能会并发坏死、感染等症状，导致膝关节畸形或功能受损[2-3]。……