胫骨平台骨折关节镜监视下复位内固定与切开复位内固定的疗效比较

Arthroscopy assisted reduction and fixation versus open reduction and internal fixation in tibial plateau fracture

目的比较关节镜监视下复位内固定与切开复位内固定方法治疗胫骨平台骨折的临床效果。方法2005年4月至2009年4月共收治48例胫骨平台骨折。分为切开复位内固定组22例（A组），其中男13例，女9例，关节镜监视下复位内固定26例（B组），其中男15例，女11例，术后随访12—24个月（平均15．3个月），切口长度、住院时间评价手术效果，Rasmussen胫骨平台骨折影像学评分系统评定骨折复位满意程度，Rasmussen评分系统评价膝关节的功能，x线评价骨折愈合效果。结果48例均获随访，切口长度A组（15．3±2．4）cm，B组（9．7±1．9）cm，住院时间A组（18．3±1．5）d，B组（11．8±2．1）d，两组差异有统计学意义（t1=6．32，P，〈0．05；t2=3．34，P1〈0．05），术后6个月Rasmussen胫骨平台骨折影像学评分A组优良率83．5％，B组94．9％，术后1年Rasmussen评分A组优良率82．7％，B组93．5％，两组差异有统计学意义。结论关节镜监视下复位内固定胫骨平台骨折手术创伤小、住院时间短、骨折复位满意、膝关节功能恢复较好，而且关节镜能早期发现和处理半月板及交叉韧带的损伤，是一种安全、可行的微创治疗手段。

Objective To compare the efficacy of arthroscopy assisted reduction and fixation with that of the conventional open reduction and internal fixation in tibial plateau fracture. Methods A retrospective analysis was conducted on 48 patients with tibial plateau fractures from April, 2005 to April, 2009. The patients were divided into Group A （ open reduction and internal fixation, n = 22） and Group B （arthroscopy assisted reduction and fixation, n = 26）. The average follow-up period was 15.3 months, ranging from 12 to 24 months. Follow-up assessment included the incision length, the hospital stay. Rasmussen radiologic scores. Rasmussen system and radiological evaluation. Results All 48 cases successfully achieved reduction and bone union. In group A, the incision length was （ 15.3 ± 2.4）cm, the hospital stay was （ 18.3 ± 1.5） d ; in groupB, the incision length was （9. 7 ± 1.9） cm, the hospital stay was （ 11.8 ± 2. 1 ） d. There was statistically significant differenece between the two groups （ t1 = 6. 32, P1 〈 0.05 ; t2 = 3.34, P2 〈 0.05）. According to the Rasmussen radiologic score, the excellent and good rate was 83.5% in group A and 94. 9% in group B. According to the Rasmussen system, the excellent and good rate was 82. 7% in group A and 93. 5% in group B. There was statistically significant differenece between the two groups. Conclusion Arthroscopy assisted reduction and fixation for tibial plateau fractures has advantages of minimally operative invasion, less hospitalization time, satisfactory reduction and good functional recovery of the knee joint. It could find and deal with the intra-joint cavity damnification in early stage, and is a safe and promising procedure for tibial plateau fracture treatment.