Objective: To compare the effects of cutting and retaining the pes anserinus tendon on effectiveness following tibial plateau fracture.
Methods: A clinical data of 40 patients with tibial plateau fracture treated with open reduction and internal fixation with plate via posteromedial approach between January 2015 and January 2020 was retrospectively analyzed, including 18 patients retained the pes anserinus tendon (study group) and 22 patients cut the pes anserinus tendon (control group) during operation. There was no significant difference in gender, age, side of affected knee, cause of injury, Schatzker classification, time from injury to operation, and associated ligament injury between the two groups ( P>0.05). The operation time, intraoperative blood loss, hospital stay, anatomic reduction rate, incidence of complications, fracture healing time, knee flexion and extension range of motion at 2 weeks and 12 months, and knee extension range of motion at 3 months after operation were recorded and compared between the two groups. The visual analogue scale (VAS) score was used to evaluate the early postoperative pain improvement at 1, 3, and 14 days after operation and hospital for special surgery (HSS) score was used to evaluate the improvement of knee function at 3, 6, and 12 months after operation.
Results: The patients in both groups were followed up 12-15 months with an average of 12.8 months. There was no significant difference in operation time, intraoperative blood loss, and fracture healing time between the two groups ( P>0.05). The hospital stay in the control group was significantly longer than that in the study group ( t=8.339, P=0.000). There was no significant difference in the anatomic reduction rate (90.9% vs. 83.3%) between the control group and the study group ( χ 2=0.058, P=0.810). There were 1 case of proximal tibial osteomyelitis, 3 cases of skin necrosis, 3 cases of traumatic arthritis, and 2 cases of lower deep venous thrombosis after operation in the control group, and 1 case of metaphyseal nonunion, 2 cases of traumatic arthritis, and 1 case of lower deep venous thrombosis in the study group, showing no significant difference in the incidence of complications (40.9% vs. 22.2%) between the two groups ( χ 2=1.576, P=0.209). In the study group, knee flexion and extension range of motion at 2 weeks and 12 months and knee extension range of motion at 3 months after operation were significantly better than those of the control group ( P<0.05). VAS scores and HSS scores in both groups improved with time after operation ( P<0.05), in addition, the HSS score and VAS score of the study group were significantly better than those of the control group ( P<0.05).
Conclusion: Compared with traditional pes anserinus tendon cutting group, pes anserinus tendon retaining group can significantly reduce postoperative short-term pain, improve postoperative knee range of motion and knee function within 1 year after operation.
目的: 比较胫骨平台骨折手术中切开与保留鹅足肌腱两种处理方式对手术疗效的影响。.
方法: 回顾分析2015年1月—2020年1月行后内侧入路切开复位钢板内固定术治疗且符合选择标准的40例胫骨平台骨折患者临床资料，其中18例术中保留鹅足肌腱（研究组），22例术中切开鹅足肌腱（对照组）。两组患者性别、年龄、患膝侧别、致伤原因、Schatzker分型、受伤至手术时间及合并韧带损伤情况比较差异均无统计学意义（ P>0.05）。记录并比较两组患者手术时间、术中失血量、住院时间、骨折解剖复位率、并发症发生率及骨折愈合时间，术后2周、12个月膝关节屈伸活动度及术后3个月站立位膝关节伸直活动度；术后1、3、14 d采用疼痛视觉模拟评分（VAS）评价患者术后早期疼痛改善情况；术后3、6、12个月采用美国特种外科医院（HSS）评分评价膝关节功能改善情况。.
结果: 两组患者均获随访，随访时间12～15个月，平均12.8个月。两组患者手术时间、术中失血量及骨折愈合时间比较差异均无统计学意义（ P>0.05），对照组住院时间显著长于研究组（ t=8.339， P=0.000）。术后对照组和研究组骨折解剖复位率（90.9% vs. 83.3%）比较差异无统计学意义（ χ 2=0.058， P=0.810）。对照组术后发生胫骨近端骨髓炎1例、切口皮肤坏死3例、创伤性关节炎3例、下肢深静脉血栓形成2例；研究组发生干骺端骨不连1例、创伤性关节炎2例、下肢深静脉血栓形成1例；两组并发症发生率（40.9% vs. 22.2%）比较差异亦无统计学意义（ χ 2=1.576， P=0.209）。研究组术后3个月膝关节伸直活动度及术后2周、12个月膝关节屈伸活动度均优于对照组（ P<0.05）。术后随时间延长，两组VAS评分及HSS评分均逐渐改善（ P<0.05），而且术后各时间点研究组HSS评分及VAS评分均优于对照组（ P<0.05）。.
结论: 与传统切开鹅足肌腱相比，保留鹅足肌腱能显著减轻患者术后早期疼痛，改善患者术后1年内膝关节活动度及提高膝关节功能。.
Keywords: Tibial plateau fracture; complication; knee range of motion; pes anserinus tendon; soft tissue injury.