关节镜监视下胫骨平台骨折的手术治疗

Surgical Treatment of Tibial Plateau Fractures under Arthroscopic Guide

目的探讨关节镜下胫骨平台骨折的复位和支撑钢板内固定方法的可行性并作临床疗效评价。方法北京通州区潞河医院骨科自2006年5月至2007年2月行关节镜下复位固定塌陷及分离移位术治疗胫骨平台骨折18例。其中男8例,女10例。平均年龄32.5岁(20～54岁)。患者中合并半月板损伤6例,内侧副韧带损伤3例。Schatzker分型:Ⅰ型7例,Ⅱ型5例,Ⅲ型4例,Ⅳ型2例。结果18例骨折患者均在3～8个月达骨性愈合,未出现关节内感染、骨筋膜室综合征等合并症。随访时间平均12个月(9～18个月)。采用Sanders等膝关节评分法评估疗效,18例患者中有14例为优,3例为良,1例为尚可。未观察到创伤性膝关节炎、膝关节内翻和外翻畸形。结论关节镜监视下治疗胫骨平台骨折通常不需切开关节,具有损伤小、操作安全、能同时发现和处理关节内合并损伤、术后康复效果好等特点。应用该法对于SchatzkerⅠ～Ⅲ型和部分Ⅳ型骨折的治疗效果满意。

Objective To explore the feasibility and evaluate the outcome of surgical treatment of tibial plateau fractures under arthroscopic guide. Methods From May of 2006 to Feb of 2007, eighteen cases of tibia plateau fractures underwent the procedures of surgical treatment under arthroscopic guide and help reduction. The patients were 32.5 （20 - 54） years old at average, male in 8 cases, female in 10 cases. Six cases combined with meniscus lesion and 3 cases with medial collateral ligament injury. For Schatzker classification, the 18 cases were divided into type Ⅰ in 7 cases, type Ⅱ in 5 cases, type Ⅲ in 4 cases and type IV in 2 cases. Results Healed fractures were found at 3 - 8 months after operation in all 18 cases, and there were no infections, compartment syndromes or other complications. The average follow-up period was 12 months（9 -18 months）. According to the Sanders evaluation criterion, 17 cases were in excellent and good conditions, and there were no traumatic arthritis, varus and valgus deformity in all cases. Conclusion Treatment of tibial plateau fractures under arthroseopic guide can avoid opening up the knee joint, it＇s less invasive and safe procedures make it possible to treat the combined injuries in the knee at the same time with rehabilitation easier. This treatment is especially effective to type Ⅰ -Ⅲ and some Ⅳ of Schatzker classification.