膝关节镜辅助微创内固定治疗胫骨平台骨折

Arthroscopic-assisted Minimally Invasive Internal Fixation for Tibial Plateau Fracture

目的探讨关节镜辅助微创内固定治疗胫骨平台骨折的临床疗效。方法 2002年1月～2009年3月,对32例胫骨平台骨折行膝关节镜下微创内固定治疗。Hohl分型:Ⅱ型14例,Ⅲ型9例,IV型9例。取膝前内、外侧标准入路进镜,依次检查整个关节腔。在膝关节镜监视下,用撬拨器将塌陷的平台解剖复位,直到关节软骨面平整。平台复位后其下的空隙用人工骨或自体骨填充,经皮或小切口用空心螺纹钉、可吸收螺钉或支持钢板固定骨折块。合并半月板及关节韧带损伤时镜下作相应处理。术后康复训练。结果术后2～4个月骨折愈合,骨折线消失,关节面平整,下肢力线正常,膝关节活动度平均大于110°,无并发症。26例随访6～24个月,平均10个月,术后6个月时按雍氏评分标准,优22例,良3例,可1例,优良率96.2%(25/26)。结论关节镜监视下复位微创内固定治疗胫骨平台骨折创伤小、并发症少、术后康复快、疗效满意。

Objective To discuss the clinical efficacy of minimally invasive internal fixation assisted with arthroscopy for patients with the tibial plateau fracture.Methods During the period of January 2002 to March 2009,we treated 32 cases of tibial plateau fracture with internal fixation by using an arthroscope.In the patients,14 cases were Hohl type Ⅱ,9 were type III,and 9 were type IV.Via the anteromedial or anterolateral approach,we explored the whole anticular cavity.Under an arthroscope,we restored the injured tibial plateau anatomically to smooth the articular cartilage,and then we used the artificial bone or an autogenous bone to fill the space under the tibial plateau,and fixed the fracture part with hollow bolt,absorbent bolt,or sustaining armor plate.Damages to the meniscus and the articular ligaments were treated at the mean time.Early rehabilitation training was carried out after the surgery.Results Bone healing was achieved in 2 to 4 months after the treatment,when the fracture line disappeared,the joint side was leveled up,the crura of force line returned to normal,and the mean of degree of knee activity was 〉110°.No patients showed complications.Follow-up was carried out in 26 of the cases for a mean of 10 months（ranged from 6 to 24 months）;at month 6,according to Yong＇s scale,22 patients achieved excellent outcomes,3 were good,and 1 was improved.The rate of excellent and good outcomes was 96.2%（25/26）.Conclusions Arthroscopic-assisted minimally invasive interal fixation is a less traumatic procedure for patients with tibial plateau fracture,leading to less complications,quick recovery and satisfied outcomes.