关节镜下胫骨平台骨折的治疗

The treatment of tibial plateau fractures with arthroscopy

目的探讨关节镜下治疗胫骨平台骨折的近期临床疗效。方法2002-01以来治疗17例胫骨平台骨折,按Schatzker分型为I型3例,Ⅱ型6例,Ⅲ型4例,Ⅳ型3例,V型1例。其中合并半月板损伤9例,前交叉韧带损伤4例,内、外侧副韧带损伤7例。常规行膝关节镜检查,观察膝关节内各结构的损伤情况,了解胫骨平台骨折的形态、移位方向和性质、软骨缺损及塌陷深度。在关节镜监视下,进行复位和固定,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。结果所有患者均无明显手术并发症,近期膝关节功能恢复满意。结论关节镜下治疗胫骨平台骨折,具有创伤小、并发症少、住院时间短、视野清晰,能同时处理关节腔内其他合并损伤,骨折愈合快、能早期锻炼,有利于膝关节功能的恢复,是一种有效的治疗方法。

Objective To Study the effect of treating tibial plateau fractures with arthroscopy. Methods A total of 17 cases with tibial plateau fractures were treated by arthroscopy since January 2002. According to Schatzker classlficatlon,there were type Ⅰ in 3 cases,type Ⅱ in 6 cases,type Ⅱ in 4 cases,type Ⅳ in 3 cases, type Ⅴ in 1 case. Of all, 9 cases had associated meniscal injury, 4 cases had the injury of the anterior eruciate ligamnent, 7 cases had the injury of MCL or LCL. As a rule, arthroscopie examination of the knee was performed,the interarticular pathology were observed,the pattern displacement orientation and extent of fracture fragments, cartilage defect and depression depth of articular surface were examined. Fracture reduction and fixation were performed and marraged arthrosocopically. Finally,the internal fixation was observed by C-arm X-ray equipment,postoperative management included early motion and delayed weight bearing.Results No surgical complication occurred in all patients,and the short-term functional recovery was satisfied.Conclusion Arthroseople management of tibial plateau fractures is effectives. It has the advantages of less surgieahauma and complications, less hospitalization,fast fracture healing,and management of associated intraarticular pathology on time. It allows early exercise and recovery of function of the knee joint.