关节镜下复位微创经皮钢板内固定治疗胫骨平台骨折

Arthroscopic reduction and minimally invasive percutaneous plate osteosynthesis(MIPPO)for treatment of the tibial plateau fracture

目的：研究关节镜下微创经皮钢板内固定（MIPPO）治疗胫骨平台骨折的手术方法和临床效果。方法：关节镜监视下治疗胫骨平台骨折55例，男31例，女24例；年龄18—75岁，平均47岁。Schatzker Ⅱ型18例，Ⅲ型20例，Ⅳ型9例，Ⅴ型5例，Ⅵ型3例。合并半月板损伤23例，前交叉韧带损伤9例，侧副韧带损伤8例。术中通过皮肤微小切口经皮插入解剖型支撑钢板，骨缺损处用自体髂骨或同种异体骨植骨，术后配合早期的功能训练。结果：所有患者均得到随访，随访时间35～50个月，平均45．6个月。采用Lysholm评分标准评价临床疗效，优46例，良5例，可3例，差1例，优良率为92．7％。结论：关节镜下应用MIPPO技术治疗胫骨平台骨折能够以最小的创伤重建关节面平整，使骨折得到坚强固定。早期行膝关节功能锻炼，以获得满意疗效。

Objective： To explore the surgical techniques and clinical effect of minimally invasive percutaneous plate osteosynthesis for treatment of the tibial plateau fracture under arthroscopy. Methods：Fifty-five patients suffered from the tibial plateau fracture were treated by arthroscopic reduction, including 31 male and 24 female. Their mean age was 47 years ranging from 18 to 75 years. According to Schatzker standard, there were 18 cases of type Ⅱ ,20 of type Ⅲ,9 of type Ⅳ ,5 of type Ⅴ,3 of type Ⅵ. The complication concluded meniscus injury in 23 cases, anterior cruciate ligament injury in 9, collateral ligament in 8. The internal fixation was achieved by minimally invasive percutaneous plate osteosynthesis （MIPPO）in which anatomic strut plates were used. The autografts of ilium or bone allografts were applied where the bone was defected. Moreover, the early rehabilitation training was carried out on patients after operation. Results ： All of the patients were followed up from 35 to 50 months. According to Lysholm knee rating system,46 cases were excellent, 5 were good, 3 were fair and 1 was poor, the excellent and good rate were 92. 7%. Conclusion： Arthroscopic MIPPO for the tibial plateau fracture can re-establish smooth of the joint by making the lest trauma so as to make the fracture fixed strongly. A satisfactory therapeautive result can be achieved by early post-surgical functional exercise.