关节镜辅助下胫骨平台骨折的微创治疗

Minimally Invasive Osteosynthesis Assisted by Arthroscope for Tibial Plateau Fractures

目的研究关节镜辅助有限切开复位内固定治疗胫骨平台骨折的疗效。方法从2006年8月-2008年7月收治30例胫骨平台骨折病例,采用Schatzker分类法:Ⅰ型5例、Ⅱ型12例、Ⅲ型9例、Ⅳ型2例、Ⅴ型1例、Ⅵ型1例,施行关节镜辅助下有限切开整复内固定治疗,术后进行随访,平均随访时间16个月,采用HSS膝关节功能评分和Ras-mussen放射学评分评价疗效。结果16例患者(53%)存在关节内软组织损伤,最终随访时依照HSS膝关节功能评分:优良率90%,依照Rasmussen放射学评分:优良率81%,1例膝关节僵直(关节活动范围0°～90°),1例发生骨关节炎。结论关节镜辅助有限切开整复内固定治疗胫骨平台骨折可以避免关节囊切开、镜下监视关节面骨折复位、镜下评价和处理骨折合并的半月板和交叉韧带等损伤,有利于准确评价伤情、减少手术创伤、有效处理关节内合并损伤,是一种安全、可行的胫骨平台骨折的微创治疗手段。

Objective To investigate the clinical effects of limited open reduction and internal fixation associated by arthroscope in treating tibial plateau fractures.Methods 30 cases with tibial plateau fractures,in which there were 5 cases of type Ⅰ,12 case of type Ⅱ,9 cases of type Ⅲ,2 cases of type Ⅳ,1 case of typeⅤ and 1 case of typeⅥ,according to the Schatzker classification,from Aug.2006 to July 2008 underwent the limited open reduction and internal fixation associated by arthroscope.The average follow-up period of 16 months.The curative effectiveness was evaluated with the Hospital for Special Surgery（HSS） knee score and the Rasmussen radiologic score.Results 16 in 30 cases（53%） were with intra-articular soft tissue lesions.HSS knee score showed a fineness rate of 90%,and Rasmussen radiologic score showed a fineness rate of 81%.1 case suffered knee joint stiffness and 1 case with osteoarthritis.Conclusion The limited open reduction and internal fixation associated by arthroscope is a safe and promising procedure in the treatment of tibial plateau fracture,with superiority in evaluating the traumatic condition,resetting joints and decreasing injury.