关节镜辅助经皮内固定和切开复位内固定治疗Schatzker Ⅱ、Ⅲ型胫骨平台骨折的比较研究

COMPARISON STUDY ON EFFECTIVENESS BETWEEN ARTHROSCOPY ASSISTED PERCUTANEOUS INTERNAL FIXATION AND OPEN REDUCTION AND INTERNAL FIXATION FOR Schatzker TYPES II AND III TIBIAL PLATEAU FRACTURES

目的比较关节镜辅助经皮内固定和切开复位内固定治疗SchatzkerⅡ、Ⅲ型胫骨平台骨折的疗效。方法 2006年8月-2010年4月,收治58例SchatzkerⅡ、Ⅲ型胫骨平台闭合骨折患者,根据治疗方法不同随机分为两组,其中38例采用关节镜辅助经皮内固定治疗(关节镜组),20例采用切开复位内固定治疗(对照组)。两组患者性别、年龄、病程、骨折类型、合并症比较,差异均无统计学意义(P>0.05),具有可比性。记录两组手术时间、切口长度、骨折愈合时间、术后并发症发生情况;按美国特种外科医院(HSS)评分标准行膝关节功能评分,测量关节活动度。结果术后两组患者切口均Ⅰ期愈合。关节镜组手术时间较对照组长,切口较对照组短,差异均有统计学意义(P<0.05)。两组患者均获12～14个月随访。术后6个月关节镜组膝关节HSS评分优于对照组,关节活动度大于对照组,差异均有统计学意义(P<0.05)。X线片检查示两组骨折均达骨性愈合,关节镜组愈合时间较对照组短,但差异无统计学意义(t=2.14,P=0.41)。关节镜组2例(5.3%)术后1周出现关节晨僵;对照组6例(30.0%)术后1周出现关节疼痛,其中3例伴关节僵直;均经对症处理后症状缓解。两组并发症发生率比较,差异有统计学意义(χ2=6.743,P=0.016)。结论关节镜辅助经皮内固定治疗SchatzkerⅡ、Ⅲ型胫骨平台骨折与切开复位内固定相比,具有术后功能恢复快、并发症少等优点。

Objective To compare the effectiveness of arthroscopy assisted percutaneous internal fixation and open reduction and internal fixation for Schatzker types II and III tibial plateau fractures.Methods Between August 2006 and April 2010,58 patients with tibial plateau fractures of Schatzker types II and III were treated with arthroscopy assisted percutaneous internal fixation（arthroscopy group,n=38）,and with open reduction and internal fixation（control group,n=20）.There was no significant difference in gender,age,disease duration,fracture type,and complication between 2 groups（P 〈0.05）.The operation time,incision length,fracture healing time,and complications were compared between 2 groups.Knee function score and the range of motion were measured according to American Hospital for Special Surgery（HSS） score standard.Results All patients achieved primary incision healing.The arthroscopy group had smaller incision length and longer operation time than the control group,showing significant differences（P 〈0.05）.The patients of 2 groups were followed up 12 to 14 months.At 6 months,the HSS score and the range of motion of the arthroscopy group were significantly greater than those of the control group（P 0.05）.The X-ray films showed bony union in 2 groups.The fracture healing time of the arthroscopy group was shorter than that of the control group,but no significant difference was found（t=2.14,P=0.41）.Morning stiffness occurred in 2 cases（5.3%） of the arthroscopy group,joint pain in 6 cases（30.0%） of the control group（3 cases had joint stiffness） at 1 week,which were cured after symptomatic treatment.There was significant difference in the incidence of complications between 2 groups（χ2=6.743,P=0.016）.Conclusion The arthroscopy assisted percutaneous internal fixation is better than open reduction and internal fixation in the treatment of tibial plateau fractures of Schatzker types II and III,because it has smaller incision length and shorter fracture healing time.