关节镜辅助下微创手术治疗胫骨平台骨折的疗效观察

Minimally invasive surgical technology combined with arthroscopy for the treatment of tibial plateau fractures

目的探讨关节镜辅助下微创治疗胫骨平台骨折的手术方法。方法回顾性分析2010年2月至2012年4月我科手术治疗的37例胫骨平台骨折患者的资料。Schatzker分型Ⅰ型3例,Ⅱ型15例,Ⅲ型15例,Ⅳ型4例。手术方法采用关节镜辅助下塌陷平台关节面撬拨、植骨、钛板螺钉内固定术。术后3～5d、1个月、3个月、6个月复查膝关节正侧位X线片观察骨折复位及愈合情况。结果 37例患者术中均获得满意复位及坚强内固定。手术切口6～10cm,平均8cm;手术时间80～120min,平均96min;出血量10～50ml,平均35ml。术后3～5d均非负重进行持续被动运动(CPM)功能锻炼及下地活动。所有患者均获随访,随访时间2～26个月,平均14个月。术后复查X线片显示骨折愈合良好,关节面复位平整,骨折愈合时间12～16周。所有患者无感染、骨折不愈合、内固定松动、断裂等并发症出现。结论在适应证明确的前提下,关节镜辅助下手术治疗胫骨平台骨折具有手术创伤小、并发症少、失败率低等优点,是治疗胫骨平台骨折的有效方法之一。

Objective To investigate the surgical method and clinical effect of minimally invasive surgical technology combined with the arthroscopy for the treatment of tibial plateau fractures. Methods From Feb, 2010 to April, 2011, 37 patients with tibial plateau fractures were treated with minimally invasive surgical technology combined with the arthroscopy. There were 13 males and 24 females with the average age of 51 years （ranged from 35 to 73 years）. According to Sehatzker classification, 3 cases were type Ⅰ, 15 cases were type Ⅱ, 15 eases were type Ⅲ, 4 cases were type Ⅳ. Patients were placed on the surgical table, the fractures were reduced by minimally invasive technology combined with arthroscopy, allograft and internal fixation. The artificial bone was implanted to the fracture. The fracture reduction and bone union were evaluated on the AP view and lateral view X-rays. Results The average incision length was 8 cm （ ranged from 6 to 10 cm ）. The average operation time was 96 min （ ranged from 80 to 120 min）. The average blood loss was 35 ml （ranged from 10 to 50 ml）. All patients were followed up for an average of 14 months （range from 2 to 26 months）. The fracture healing time ranged from 12 to 16 weeks. There were no serious complications such as wound infection, nonunion, screw loosening. Conclusion Minimally invasive surgical technology combined with arthroscopy is an effective method for treating tibial plateau fractures if the indication is appropriate.