关节镜结合LCP内固定治疗低能量胫骨平台骨折回顾性临床研究

Retrospective Clinical Study of Treatment with Arthroscopy Combined with Locking Compress Plate(LCP) in Senile Patients with Low Energy Tibial Plateau Fractures

目的通过比较关节镜结合锁定加压钢板（LCP）内固定与切开复位内固定治疗SchatzkerⅡ、Ⅲ型胫骨平台骨折，回顾性评价关节镜结合LCP内固定治疗的临床效果。方法2008年9月-2011年12月对65例SchatzkerⅡ、Ⅲ型胫骨平台骨折患者资料回顾性分析，根据治疗方法不同随机分为两组，其中35侧采用关节镜结合LCP内固定（A组），30例采用小切口切开复位内固定治疗（B组）。对两组患者的手术时间、术中出血量、术后引流量、下地负重时间、骨折愈合时间、术后并发症及膝关节功能优良率等进行比较分析。结果两组患者均获得随访，随访时间12～26个月，平均16个月，骨折全部愈合，平均愈合时间3．2个月。手术时间、术中出血量、术后引流量、临床愈合时间差异均有统计学意义（P〈0．05）。两组下地负重时间比较差异无统计学意义（P〉0．05）。按RasmusSen评分标准评定：A组优22例，良10例，可3例；B组优13例，良8例，可9例，两组比较差异有统计学意义（P〈0．05）。并发症为创伤性关节炎：A组3例（8．6％），B组9例（30％）；膝关节僵硬：A组0例，B组3例（10％）两组比较差异有统计学意义（P〈0．05）。结论关节镜结合LCP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，有较高的实用性和安全性。

Object i ve To retrospectively analyze the results of treatment with arthroscopy combined with Locking compress plate （LCP） for SchatzkerⅡ and Ⅲ tibial plateau fracture in comparison with open reduction and internal fixation.Methods In Sep 2008 to Dec 2011,65 patients with tibial plateau fractures of Schatzker types II and III were treated with arthroscopy combined with Locking compress plate （LCP） （group A 35 cases）,and with open reduction and internal fixation （group B 30 cases）.The clinical outcomes were compared between the 2 methods,including operation time,the volume of blood loss,postoperative drainage volume,Down load time,fracture healing time,postoperative complications and the excellent and good rate of knee function.Results All cases were followed-up （mean 16 months,range 12 - 26 months）.All fractures healed.Fracture healing time was 10- 12 weeks in group A,11 - 12 weeks in group B（P 〈 0.05）.Operation time,the volume of blood loss, postoperative drainage volume and fracture healing time,difference have statisticall significant（P 〈 0.05）.Two groups there was no statistically significant difference compared to down load time（P 〉0.05）.By Rasmussen scoring system,in group A find 22 excellent cases,10 good ones,3 fair ones,and in group B find 13 excellent cases,8 good ones,9 fair ones,（P 〈 0.05）.After operation,3 cases of traumatic arthritis occurred in group A（8.6%）and 9 cases ccurred in group B（30%）.3 cases of anchylosises ccurred in group B（10%） and 0 casesin group A（P 〈 0.05）. Conclusion The Arthroscopy combined with LCP internal fixation is better than open reduction and internal fixation in the treatment of tibial plateau fractures of Schatzker types 11 and Ill,because it has advantages of rapid recovery,fewer complications.It has higher practicability and safety.