关节镜辅助下微创内固定系统治疗胫骨平台骨折的临床疗效

Clinical effects of less invasive stabilization systems assisted with arthroscopy for tibial plateau fracture

目的探讨关节镜辅助下微创内固定系统(LISS)治疗胫骨平台骨折的临床疗效。方法回顾性分析浙江省人民医院2013年7月—2015年1月期间50例经6个月以上随访的胫骨平台骨折患者的临床资料,均在关节镜辅助下采用微创内固定系统对骨折进行治疗。首先在关节镜下探查半月板、韧带等软组织损伤情况并进行修复,之后在关节镜辅助下复位骨折并采用微创内固定系统对骨折进行固定,术后进行循序功能锻炼。定期复查并记录患者术后并发症发生的情况、关节活动度改变情况、骨折愈合情况并采用Rasmussen评分系统对患者膝关节功能进行评价。结果上述所有患者术后6个月内出现骨折畸形愈合3例,手术切口坏死或感染2例;术后6个月患者膝关节屈膝达75°~115°,平均(93.4±7.8)°;伸膝为0°~15°,平均(3.9±1.8)°;骨折临床愈合时间为2.5~7.0个月,平均(3.8±1.1)个月;采用Rasmussen评分系统对患者膝关节功能进行评价,显示治疗优良率为88%。结论关节镜辅助下微创内固定系统治疗胫骨平台骨折能够在关节镜监视下对骨折进行复位,有利于关节面及下肢力线的恢复,促进关节功能的恢复,具有创伤性小、并发症少、视野良好等优点,值得临床推广。

Objective To investigate the clinical effects of less invasive stabilization systems（LISS） assisted with arthroscopy for tibial plateau fracture. Methods A retrospective analysis of 50 patients with tibial plateau fracture who were followed up for 6 months or more in our hospital from July,2013 to January ,2015 was conducted. The exploration and repair of arthroscopic meniscus ,ligaments and other soft tissue injury were attempted to implement with arthroscopy, and all the cases underwent joint reduction and were treated with LISS assisted with arthroscopy. The postoperative functional exerci- ses were done step-by-step. The complications ,joint range of motion, fracture healing time and Rasmussen knee functional score were evaluated. Results Six months after the operation ,3 cases were with fracture malunion ,2 cases with incision necrosis or infection. The mean knee joint ROM was （93.4 ± 7.8 ） at extension and （3.9 ± 1.8 ） at flexion. The fracture healing time were 2.5 - 7.0 months, with an average of （ 3.8 ± 1.1 ） months. Rasmussen knee functional score showed that the rate of excellent and good was 88%. Conclusion Less invasive stabilization systems assisted with arthroscopy for tibial plateau fracture can proceed fracture reduction with the advantage of better visual field ,fewer complications and less damage and satisfactory restoration,which deserves clinical expansion.