关节镜下微创内固定系统治疗外侧胫骨平台骨折合并软组织损伤的疗效

Arthroscopy combined with less invasive stabilization system for treatment of tibial plateau frafractures accompanied with soft tissue injuriesctures

背景：对于胫骨平台骨折，在传统的切开手术中，为了观察关节面的复位情况，要切开关节囊，切断半月板胫骨韧带。而这容易导致术后膝关节粘连、本体感觉障碍、关节疼痛，并增加感染风险，影响患者预后。 目的：探讨关节镜下微创内固定系统（LISS）治疗外侧胫骨平台骨折伴软组织损伤的效果。 方法：本研究纳入2011年9月至2013年6月我院连续收治的外侧胫骨平台骨折合并软组织损伤患者67例。采用随机数字表法将其分为两组：34例采用关节镜下LISS内固定治疗（关节镜组），33例采用传统的切开复位内固定治疗（切开组）。记录两组患者的手术时间、术中出血及住院时间。术后第2天根据X线片评价骨折复位情况，术后1年随访时依据Rasmussen评分系统评价膝关节功能。 结果：关节镜组术中出血显著少于切开组[（97.1±37.9）ml vs（183.8±65.4）ml，t＝5.366，P＜0.05]，但手术时间和住院时间两项比较无显著统计学差异（P＞0.05）。术后第2天X线检查结果显示关节镜骨折复位的优良率显著高于切开组（91.2%vs 78.8%，χ2＝4.213，P＜0.05）。所有患者获得12-36个月，平均（15.8±3.7）个月随访。术后1年随访时，关节镜组的膝关节功能优良率显著优于切开组（85.3%vs 69.7%，χ2＝6.329，P＜0.05）。 结论：关节镜下LISS固定治疗外侧胫骨平台骨折伴软组织损伤的效果确切。

Background：In general, the joint capsule has to be opened and meniscal tibial ligament needs to be cut off in the process of open reduction and internal fixation for the treatment of tibial plateau fracture. It easily leads to postoperative adhesion of the knee, disorder of proprioceptive sense, joint pain, and increased risk of infection. Objective：To investigate the therapeutic effect of arthroscopy combined with less invasive stabilization system （LISS） on tibial plateau fractures accompanied with soft tissue injuries. Methods：A consecutive series of 67 patients, who suffered from lateral tibial plateau fractures accompanied with soft tissue injuries and were treated in our hospital from September 2011 to June 2013, were enrolled in this study and randomly divid-ed into two groups according to random digits table. Of them, 34 patients received LISS under arthroscope （arthroscopy group） and 33 underwent traditional open reduction and internal fixation （control group）. Operation time, intraoperative blood loss and hospital stay were recorded. The injured sites were observed by X-ray on day 2 after operation. The knee joint function was evaluated one year after operation according to Rasmussen scoring. Results： Intraoperative blood loss in the arthroscopy group was significantly less than that in the control group （[97.1 ± 37.9] ml vs [183.8±65.4） ml, t=5.366, P〈0.05）, but there were no significant differences in operation time or hospitalization time between two groups （P〉0.05）. X-ray showed that the reset of fractures in the arthroscopy group was better than that in the control group （91.2%vs 78.8%,χ2=4.213, P〈0.05）. The average duration of follow-up was （15.8±3.7） months （range, 12-36 months） in all the patients. After one year of follow-up, the knee function of the arthroscopy group was significantly su-perior to that of the control group （excellent-and-good rate：85.3%vs 69.7%,χ2=6.329, P〈0.05）. Conclusions：Arthroscopy combined with LISS is an effective treatment for tibial plateau fractures accompanied with soft tissue injuries.