膝关节囊外复位内固定治疗胫骨平台骨折的疗效观察

EFFECTIVENESS OF OPEN REDUCTION AND INTERNAL FIXATION WITHOUT OPENING JOINT CAPSULE ON TIBIAL PLATEAU FRACTURE

目的探讨膝关节囊外复位内固定治疗胫骨平台骨折的安全性和疗效。方法以2011年7月-2013年7月收治且符合选择标准的51例胫骨平台骨折患者作为研究对象,随机分为两组。试验组17例以有限切开膝关节囊外复位内固定治疗,对照组34例以常规打开关节囊直视下骨折复位内固定治疗。两组患者性别、年龄、致伤原因、伤后至入院时间、损伤侧别以及骨折分型比较,差异均无统计学意义（P〉0.05）。比较两组手术时间、术中出血量、切口长度及甲级愈合率,评价手术安全性。X线片观察骨折愈合情况,测量胫股角和胫骨平台关节面塌陷程度;末次随访时采用美国特种手术医院（HSS）膝关节功能评分量表,综合评价两组手术疗效。结果与对照组比较,试验组术中出血量显著减少,手术切口缩短（P〈0.05）;但手术时间以及切口甲级愈合率比较,差异无统计学意义（P〉0.05）。术后两组患者均获随访,其中试验组随访时间为12-30个月,平均20.4个月;对照组为12-31个月,平均18.2个月。X线片示两组骨折均愈合,初步愈合时间比较差异无统计学意义（t=1.382,P=0.173）。两组术后12个月胫股角及末次随访时关节面塌陷程度比较,差异均无统计学意义（P〉0.05）;但试验组HSS总评分显著高于对照组,比较差异有统计学意义（t=3.161,P=0.003）。结论采用膝关节囊外复位内固定治疗胫骨平台骨折,可以减少术中出血量、缩短手术切口;利用关节囊的软组织牵拉复位,可以更好地恢复并协助维持塌陷的关节面,避免关节僵硬,提高术后膝关节功能。

Objective To introduce the surgery method to reset and fix tibial plateau fracture without opening joint capsule,and evaluate the safety and effectiveness of this method.Methods Between July 2011 and July 2013,51 patients with tibial plateau fracture accorded with the inclusion criteria were included.All of 51 patients,17 cases underwent open reduction and internal fixation without opening joint capsule in trial group,and 34 cases underwent traditional surgery method in control group.There was no significant difference in gender,age,cause of injury,time from injury to admission,side of injury,and types of fracture between 2 groups（P〉0.05）.The operation time,intraoperative blood loss,incision length,incision healing,and fracture healing were compared between 2 groups.The tibial-femoral angle and collapse of joint surface were measured on X-ray film.At last follow-up,joint function was evaluated with Hospital for Special Surgery（HSS） knee function scale.Results The intraoperative blood loss in trial group was significantly less than that in control group（P〈0.05）.The incision length in trial group was significantly shorter than that in control group（P〈0.05）.Difference was not significant in operation time and the rate of incision healing between 2 groups（P〉0.05）.The patients were followed up 12-30 months（mean,20.4 months） in trial group and 12-31 months（mean,18.2 months） in control group.X-ray films indicated that all cases in 2 groups obtained fracture healing;there was no significant difference in the fracture healing time between 2 groups（t=1.382,P=0.173）.On X-ray films,difference was not significant in tibial-femoral angle and collapse of joint surface between 2 groups（P〉0.05）.HSS score of the knee in trial group was significantly higher than that of control group（t=3.161,P=0.003）.Conclusion It can reduce the intraoperative blood loss and shorten the incision length to use open reduction and internal fixation without opening joint capsule for tibial plateau fracture.Traction of joint capsule is helpful in the reduction and good recovery of joint surface collapse.In addition,the surgery without opening joint capsule can avoid joint stiffness and obtain better joint function.