关节镜监视下复位内固定治疗胫骨平台骨折疗效分析

Effect of arthroscopically assisted reduction and internal fixation for tibial plateau fractures

目的：对比分析关节镜监视下复位内固定术与传统切开复位内固定术治疗胫骨平台SchatzkerⅠ~Ⅳ型骨折的临床疗效。方法选择需要手术治疗的SchatzkerⅠ~Ⅳ型胫骨平台骨折共110例随机分组，关节镜监视下复位内固定术治疗57例，设为观察组；传统切开复位内固定术治疗53例，设为对照组。两组随访时间均超过6个月。对比分析两组患者手术时间、切口大小、骨折愈合时间、术后3个月及6个月膝关节Rasmussen功能评分、疗效以及并发症情况。结果观察组与对照组手术时间分别为（69.3±14.8）min、（104.8±43.7）min（t=5.788，P〈0.05），切口大小分别为（6.7±2.1）cm、（13.8±2.7） cm（t=15.454，P〈0.05），骨折愈合时间分别为（3.23±0.72）月、（3.76±0.68）月（t=3.962，P〈0.05），术后3个月Rasmussen评分分别为（23.23±3.72）分、（20.76±3.68）分（t=3.498，P〈0.05），术后6个月Rasmussen评分分别为（26.14±2.74）分、（24.06±3.54）分（t=3.460，P〈0.05），手术优良率分别为80.70%（46/57）、54.72%（29/53）（χ2=8.548，P〈0.05），术后并发症发生率分别为5.26%（3/57）、23.96%（18/53）（χ2=14.644，P〈0.05）。结论与对照组相比，关节镜监视下复位内固定治疗简单的胫骨平台骨折（Schatzker Ⅰ~Ⅳ型）具有创伤小，手术时间短，骨折愈合和关节功能恢复时间短，疗效好以及并发症少等优点，值得临床推广。

Objective To contrastively analyse the effect between arthroscopy-assisted and traditional operative reduc-tion and inter fixation of Schatzker type Ⅰ~Ⅳtibial plateau fractures. Methods 110 patients underwent surgical operation for Schatzker typeⅠ~Ⅳtibial plateau fracture were observed. 57 patients in observation group were treated by arthroscopy-assisted operative management in tibial plateau fractures. The other 53 patients in control group were treated by traditional open reduction and internal fixation. The following up time was more than 6 months. The operation time, the incision length, Rasmussen func-tional score of knee at 3 months and 6 months after operation, fracture healing time, the excellent and good rate of operation and postoperative complication rate were compared between two groups. Results The operation time and the fracture healing time in observation group were shorter than those in control group [（69.3±14.8）min vs （104.8±43.7）min （t=5.788, P〈0.05）;（3.23± 0.72） months vs （3.76±0.68） months （t=3.962, P〈0.05）]. The incision length in observation group was smaller than that in con-trol group [（6.7±2.1）cm vs （13.8±2.7）cm （t=15.454,P〈0.05）]. The Rasmussen funtional scale at 3 months and 6 months in obser-vation group were higher than those in control group [（23.23±3.72） vs （20.76±3.68） （t=3.498, P〈0.05）; （26.14±2.74） vs （24.06±3.54） （t=3.460, P〈0.05）]. The excellent and good rate of operation in observation group was higher than that in control group [（80.70% vs 54.72%） （χ2=8.548,P〈0.05）]. The postoperative complication rate in observation group was lower than that in control group [（5.26%vs 23.96%） （χ2=14.644, P〈0.05）]. Conclusion Compared with the traditional operative reduction and internal fixation, arthroscopy-assisted reduction and internal fixation in the treatment of Schatzker type Ⅰ~Ⅳ fractures of the tibial plateau has better effect and advantages of short operation time, short fracture healing time, good functional recovery of knee joint and fewer complications. It is worthy of clinical application.