关节镜下微创治疗胫骨髁部骨折的分型和方法

Classification and method for the treatment of the tibial plateau fracture with arthroscopy

目的:探讨通过关节镜监视下行复位内固定治疗胫骨髁部骨折的分型和治疗方法。方法:胫骨髁部骨折31例,男18例,女13例;年龄11～55岁,平均32.2岁。合并半月板损伤3例,前交叉韧带损伤5例。骨折按AO分型:B1型22例,B2型6例,C1型2例,C2型1例;根据X线特征和关节镜下所见分型:Ⅰ型14例,Ⅱ型5例,Ⅲ型12例。在关节镜监视下复位,分别使用螺栓、拉力螺钉、钢丝内固定。结果:所有患者均获得随访,时间4个月～4年。30例切口均顺利愈合,1例伤口拆线后1个月钢丝部分外露。无伤口和关节内感染,无关节痛、关节粘连和关节不稳定。术后3个月后患膝自主活动范围与健侧相同,参考HSS膝关节评分标准,所有患者临床疗效均为优(>85分)。结论:关节镜下治疗胫骨髁部骨折具有微创、高效等优点;胫骨髁部骨折Ⅰ、Ⅱ、Ⅲ分型方法简单易用,对关节镜下治疗胫骨髁部骨折的适应证和治疗方法有一定的指导意义。

Objective：To explore a minimal invasive surgery technique and classification with arthroscopy for the treatment of tibial plateau fracture. Methods：There were 31 patients of tibial condylar fracture involving 18 males, 13 females with an average age of 32.2 years ranging from 11 to 55. Three cases were suffered meniscus tear and 5 were anterior cruclare ligament injury. According to AO classified there were 22 cases of type B1,6 cases of type B2,2 cases of type C1 and 1 case of type C2. According to the severity of fracture and difference of surgery technique, all cases were classified into three types,type Ⅰ was in 14 cases,type Ⅱ was in 5 cases and type was in 12 cases. The tibial condylar fracture were reduced and fixed with wire or screw through arthroscopy. Results： All patients were followed-up for 4 months to 4 years. All the wounds were healed except one patient＇s wire was exposure in the wound 1 month later. Neither wound nor joint cavity was infected. There was no pain, no joint adhesion and no instability. The rage of active motion of all the inju- ried knee was the same of the normal side, referencing HSS scoring, all patients achieved good outcome （ 〉 85 scores）. Conclusion ： Arthroscopic treatment of tibial plateau fracture is minimal invasive and efficient and the classification of type Ⅰ ,type Ⅱ and type Ⅲ is simple and useful.