关节镜辅助微创治疗B型胫骨平台骨折的长期疗效分析

The long-term effect of arthroscopy assisted minimally invasive treatment of type B tibial plateau fractures

目的探讨关节镜辅助下微创治疗B型胫骨平台骨折的长期疗效。方法选择2010年7月-2014年7月该科诊治的B型胫骨平台骨折的患者,共16例,均无其他部位骨折。术前行膝关节正侧位摄片、CT平扫及三维重建明确诊断及骨折分型。术中首先进行关节镜下探查,明确关节内骨折情况,处理合并损伤的半月板等关节内结构。然后经小切口在平台骨折侧建立复位隧道,并在关节镜监视下进行复位,再以钢板螺钉固定。复位骨隧道内植骨预防塌陷。术毕患膝加压包扎,留置伤口引流1~2 d,并持续冰敷。术后第3天开始CPM机辅助行关节活动锻炼。第7~10天出院,佩戴可调节膝关节活动支具积极无负重康复锻炼。术后6~8周支具保护下开始负重行走。术后6、12和24周定期随访。术后1年左右,待骨折愈合再次手术取除内固定。结果所有患者无围手术期和术后并发症。初次术后定期随访,所有患者均在术后9~12个月内获得骨性愈合,未出现患膝疼痛等症状。再次取内固定手术顺利。Lysholm膝关节功能评分取除内固定术后（92.5±5.7）和骨折术后（90.5±7.0）均较骨折术前（50.6±6.3）明显增加,差异有统计学意义（P〈0.05）。结论关节镜辅助微创治疗B型胫骨平台骨折创伤小、恢复快、并发症少、骨折愈合率高,长期疗效良好,具有较高的临床应用价值。

【Objective】To investigate the long-term effect of arthroscopy assisted minimally invasive treatment of type B tibial plateau fractures. 【Methods】16 cases diagnosed with type B tibial plateau fracture were collected from July 2010 to July 2014. Preoperative examinations such as anteroposterior and lateral radiographs of the knee,three-dimensional computed tomography（CT） scan were recommended to definitively understand the fracture pattern.Arthroscopy was firstly conducted to confirm intra-articular fractures and deal with concomitant pathology such as meniscal tear, followed by arthroscopy assisted minimally invasive surgery of fracture reduction and internal fixation.After operation, physical rehabilitation exercises and regular clinical follow-up were carried out as planned. About 1year postoperation, internal fixation was removed after bone healing.【Results】No patient experienced any perioperative and postoperative complications, and without symptoms like knee pains, all cases received bone healing in 9months. Internal fixation was removed successfully. Statistical analysis showed that the Lysholm knee score after removal of internal fixation and that after fracture surgery were significantly higher than that of preoperation（92.5 ±5.7, 90.5 ± 7.0 vs 50.6 ± 7.3, P〈0.05）.【Conclusion】Arthroscopy assisted treatment of type B tibial plateau fractures gains long-term beneficial effects for its minimal invasion, quick recovery, less complications and high rate of bone healing, which has high application value in clinic.