关节镜监视下结合锁定钢板与前外侧联合后路小切口治疗胫骨平台骨折的病例对照研究

Case-control studies on therapeutic effects for the treatments of tibial plateau fractures between arthroscopic technique in minimally invasion surgery and minimally invasive internal fixation with plates and screws

目的:探讨关节镜监视下结合锁定钢板治疗胫骨平台骨折和传统前外侧切口联合后路小切口钢板固定治疗胫骨平台骨折的临床应用效果。方法:回顾性研究2006年12月至2010年6月收治的胫骨平台骨折69例。按Schatzker分型:Ⅰ型5例,Ⅱ型5例,Ⅲ型25例,Ⅳ型20例,Ⅴ型9例,Ⅵ型5例。关节镜下结合锁定钢板治疗36例,男21例,女15例;年龄17～59岁,平均34.2岁。前外侧切口联合后路小切口钢板固定治疗33例,男19例,女14例;年龄18～62岁,平均35.4岁。比较2组手术时间、术中出血量、术后引流量、住院时间、下地负重时间、Rasmussen评分及术后并发症等指标。结果:69例均获随访,时间6～12个月,平均10.3个月,所有患者未出现感染、平台塌陷、再次骨折、关节僵直等并发症。2组下地负重时间、术后并发症及膝关节功能恢复情况差异无统计学意义(P>0.05),手术时间、术中出血量、术后引流量、住院时间、临床愈合时间差异有统计学意义(P<0.05),关节镜下结合锁定钢板治疗组较前外侧切口联合后路小切口组手术时间短,术中和术后出血量少,术后愈合快。结论:采用关节镜下结合锁定钢板治疗胫骨平台骨折具有创伤小、恢复快等优点。

Objective：To investigate therapeutic effects of minimally invasive arthroscopic internal fixation with plates and screws in treating tibial plateau fractures. Methods：A retrospective study from December 2006 to June 2010 was done on 69 patients with tibial plateau fractures. According to Schatzker classification,5 patients were typeⅠ,5 patients were typeⅡ,25 patients were typeⅢ,20 patients were typeⅣ,9 patients were typeⅤand 5 patients were type Ⅵ. Thirty-six patients were treated with arthroscopy-assisted reduction and internal fixation, including 21 males and 15 females,ranging in age from 17 to 59 years（averaged, 34.2 years）;another 33 patients were treated with small incision and fixed with plates and screws,including 19 males and 14 females,ranging in age from 18 to 62 years （averaged,35.4 years）. The operation time,blood loss during operation,drainage volume of blood,healing time,weight-bearing time and function of effected knee were compared between the two groups. Results：All the patients were followed up,and the duration ranged from 6 to 12 months（averaged,10.3 months）. All the patients had no complications such as infection,articular collapse,re-fracture and joint stiffness. There were no significant differences in weight-bearing time,complications and Rasmussen scores between two groups（P0.05）;but there were significant differences in the operative time,blood loss,drainage volume of blood,hospital stay time,the healing time between two groups（P0.05）. The results showed that arthroscopy-assisted technique was better than minimally invasive internal fixation in operation duration,blood loss during operation and the healing time. Conclusion：Different types of fracture of tibial plateau should be treated with different surgical treatments. Arthroscopic technique for reduction of fractures,which has less influence on bony union and minimally invasive,and can provide a good clinical outcome.