关节镜导引下胫骨平台骨折的微创治疗

Arthroscopically assisted treatment of tibial plateau fractures

目的 探讨在关节镜导引下对胫骨平台骨折进行微创治疗的手术方法及近期疗效。方法 12例胫骨平台骨折，Schatzker分型为Ⅰ型4例，Ⅱ型2例，Ⅲ型5例，Ⅳ型1例。术前摄X片和CT平扫，术中在关节镜导引下，首先对合并损伤进行相应处理，然后对骨折进行解剖复位，通过螺钉和克氏针等固定，最后C形臂X线机透视确认，术后坚持早锻炼、晚负重的原则。结果 所有患者均在3个月骨性愈合，未出现切口愈合不良、感染和骨筋膜间隔综合征等早期并发症，随访6～10个月，无创伤性膝关节炎和膝关节内翻、外翻畸形。根据Rasmussen评分，11例为优良，1例Schatzkerm型为可，本组评分为（26±3）。结论 在治疗SchatzkerⅠ～Ⅳ型胫骨平台骨折时，采用关节镜导引下的小切口结合少量固定的手术，具有创伤小、可同时处理关节腔内的其他损伤等优势，可以获得骨折愈合快、膝关节功能良好的近期疗效，值得推广应用。

Objective To discuss minimal surgical treatment of tibial plateau fractures under arthroscope and recent clinical outcome. Methods of 12 cases with tibial plateau fractures were treated by arthroscopic fixation from March 2005 to March 2006. There were four cases of type I fracture,tow type 1] , fife type ]]] and one type IV based on Schatzker criteria. Before operation, X - ray and CT examination were done. During operation, the combined injures were treated firstly. Then, the dissociative fragments were managed with anatomic reduction and fixated with screws or nails. Finally, the internal fixation was observed by C- arm X- ray equipment. Postoperative management included early motion and delay weight bearing. Results All the fractures were healed with 3 months,with no early complications such as poor wound healing, infection or osteofascial compartment syndrome. All patients were followed up for 6-10 months showed no traumatic knee osteoarthritis,inversion or eversion of the knee. According to the Rasmussen scoring system, 11 cases got excellent or good results but one average, with total score of 26 ± 3. Conclusion As for Schatzker type Ⅰ - Ⅳ tibial plateau fractures, arthroscopically assisted limit incision in combination with some fixation techniques is characterized by minimal invasion, fast fracture healing, sound knee joint function and worths further clinical application.