关节镜辅助有限切开内固定治疗胫骨平台骨折

The treatment of limited open reduction and internal fixation assisted by arthroscopy for tibial plateau fracture

目的探讨关节镜辅助下有限切开内固定治疗胫骨平台骨折的效果。方法选择2010年1月～2012年1月本院采用膝关节镜检查及监测下复位骨折加有限切开内固定治疗胫骨平台骨折患者23例。按照Schatzker分型：Ⅱ型5例，Ⅲ型11例，Ⅳ型6例，Ⅴ型1例。Ⅱ～Ⅳ型患者采取空心螺钉或微创锁定加压钢板固定治疗，Ⅴ型患者采取双侧解剖板固定治疗。结果2l例患者获得随访6～12个月，平均10个月，所有患者骨折均骨性愈合，关节面平整，骨块未出现移位、塌陷，无膝关节内外翻畸形，平均愈合时间4个月。按照Lysholm膝关节评分，优19例（占82．6％），良3例（占13．0％），差1例（占4.3％），优良率为95．7％。结论关节镜辅助有限切开内固定治疗胫骨平台骨折，对关节创伤小，有利于解剖复位，固定牢靠，患肢功能好，并发症少。

Objective To discuss the effect of the treatment of limited open reduction and internal fixation assisted by arthroscopy for tibial plateau fracture. Methods 23 patients with tibial plateau fracture were given the surgery of reduction of fracture,limited open reduction and internal fixation under the examination and monitor of arthroscopy.The patients＇ number of type Ⅱ, Ⅲ, Ⅳ, Ⅴ were 5,11,6,1 cases respectively according to Schatzker classification.The patients of type Ⅱ -Ⅳ were fixed by hollow screw or minimally invasive locking compression plate,the patients of type Ⅴ were fixed by bilateral anatomy plate. Results 21 case of patients were followed up from 6-12 months（mean time of four months）,all of these fractures were cured and the articular plane was smoothing,there was no displacement or collapse of bone block,and no overall deformity of knee.The mean time of curing was 4 months.The number of excellent, good and worse patients after surgery was 19 cases（accounted for 82.6%）,3 cases（accounted for 13.0%） and 1 cases（accounted for 4.3%） respectively according to the Lysholm score of knee joint,and the total good rate was 95.7%. Conclusion The treatment of limited open reduction and internal fixation assisted by arthroscopy for tibial plateau fracture has little wounds for joint and beneficial to anatomical reduction.Its fixation is hard and the limb function is good with less complication.