关节镜下微创治疗和切开复位内固定治疗老年胫骨平台骨折的临床比较

Effect of arthroscopy assisted percutaneous internal fixation and open reduction internal fixation for tibial plateau fracture in the elderly patients

目的比较关节镜下微创治疗和切开复位内固定治疗老年患者SchatzkerⅠ~Ⅳ型胫骨平台骨折的疗效。方法 2013年4月至2015年4月我院收治的60例老年胫骨平台闭合性骨折患者,随机分为2组,其中30例采用关节镜下微创治疗（关节镜组）,30例采取切开复位内固定治疗（对照组）。观察并比较2组手术时间、切口长度、术中出血量、术后引流量及术后并发症发生情况及骨折愈合时间、术后1年VAS评分、膝关节功能评分（HSS评分）、膝关节活动度。结果关节镜组切口长度明显短于对照组,差异具有统计学意义（P〈0.01）。关节镜组骨折愈合时间与对照组比较,差异没有统计学意义（P〉0.05）。关节镜组术后1年VAS评分、HSS评分及膝关节活动度明显优于对照组（P〈0.05）。关节镜组术后1例（3.33%）患者出现膝关节僵硬,对照组8例（26.67%）患者术后出现膝关节疼痛伴僵硬,经对症治疗后症状缓解,2组比较差异具有统计学意义（P〈0.05）。结论关节镜下微创治疗老年SchatzkerⅠ~Ⅳ型胫骨平台骨折切口小,并发症少,值得临床推广。

Objective To compare the effect of arthroscopy assisted percutaneous internal fixation and open reduction internal fixation for Schatzker typeⅠ~ Ⅳ tibial plateau fracture in the elderly patients. Methods From April 2013 to April2015,60 elderly inpatients with tibial plateau fracture of Schatzker typesⅠ-Ⅳ in our hosipital were enrolled,and randomly divided into arthroscopy group and control group,with 30 cases in each group. The operation time,incision length,amount of bleeding during operation,postoperation drainage volume,incidence rate of complications,fracture healing time,score of VAS and knee function,the range of motion 1 year after operation were observed and compared between two groups. Results The incision length in arthroscopy group was significantly smaller than that in control group（ P〈0. 01）.One year after the operation,the scores of VAS and HSS and the range of motion in arthroscopy group were significantly better than those in control group（ P〈0. 05）. Morning stiffness occurred in 1 case（ 3. 33%） of the arthroscopy group,while joint pain and stiffness occurred in 8 cases（ 26. 67%） of the control group,which were cured after symptomatic treatment. There was significant difference in the incidence rate of complications between two groups（ P〈0. 05）. Conclusions The arthroscopy assisted percutaneous internal fixation is better than open reduction internal fixation in the treatment of Schatzker typeⅠ-Ⅳtibial plateau fracture in the elderly patients,and it has smaller incision length and shorter fracture healing time.