膝关节镜下辅助复位微创内固定手术治疗胫骨平台SchatzkerⅠ-Ⅲ型骨折疗效分析

Effect of minimally invasive internal fixation under knee arthroscopy in treatment of type Ⅰ-Ⅲ tibial plateau fracture

目的探讨膝关节镜下辅助复位微创内固定手术治疗胫骨平台SchatzkerⅠ-Ⅲ型骨折的疗效。方法选取广东省汕头市第二人民医院2013年1月—2015年11月收治的胫骨平台SchatzkerⅠ-Ⅲ型骨折患者60例,其中男性44例,女性16例;年龄20~70岁,平均45.0岁。致伤原因:道路交通伤24例,坠落伤19例,重物砸伤17例。根据随机数字表法将其分为观察组和对照组各30例,观察组行膝关节镜下辅助复位微创内固定术,对照组行传统切开复位内固定术,术后随访12~20个月,平均15.5个月。比较两组术中及术后一般资料、术后胫骨平台解剖学参数、Rasmussen复位解剖学评分及膝关节美国特种外科医院(HSS)评分。结果观察组术中出血量(107.7±12.29)mL和骨折愈合时间(26.7±1.94)周,均低于对照组的(137.8±21.16)mL和(30.7±2.63)周,差异有统计学意义(P<0.05)。术后3、6、12个月两组胫骨平台内翻角、胫骨平台后倾角和Rasmussen复位解剖学评分差异均无统计学意义(P>0.05)。术后3、6、12个月观察组HSS评分均高于对照组,差异均有统计学意义(P<0.05)。至末次随访,两组手术效果差异无统计学意义(P>0.05)。结论相比传统切开复位内固定治疗胫骨平台SchatzkerⅠ-Ⅲ型骨折,膝关节镜下辅助复位微创内固定术对软组织损伤小,更利于骨折愈合及术后膝关节功能恢复,值得临床推广。

Objective To explore the effect of minimally invasive internal fixation under knee arthroscopy in treatment of type Ⅰ-Ⅲ tibial plateau fracture.Methods Sixty patients with Ⅰ-Ⅲ tibial plateau fracture treated in our hospital from Jan.2013 to Nov.2015 were selected.There were 44 males and 16 females,with an average of45.0 years（range,20-70 years old）.There were 24 cases of road traffic accident injury,19 cases of falling injury and 17 cases of heavy-objects hitting injury.They were divided into observation group（30 cases） and control group（30 cases） according to random number table method.The observation group was given minimally invasive internal fixation under knee arthroscopy and the control group was given traditional open reduction and internal fixation.The clinical data was compared between the two groups.Results The blood loss and fracture healing time of the observation group was（107.7±12.29） mL,（26.7±1.94） weeks,respectively,which were less than those of the control group（（137.8±21.16） mL,（30.7±2.63） weeks,P〈0.05）.There was no significant difference in tibial plateautibial shaft angle,posterior slope and Rasmussen anatomical scores at 3,6 and 12 months after operations between two groups（P〈0.05）.The HSS scores of the observation group were higher than those of the control group at 3,6and 12 months after operations（P〈0.05）.At the last follow-up,there was no significant difference in the operation effect between two groups（P〉0.05）.Conclusion As for type Ⅰ-Ⅲ tibial plateau fracture,compared with traditional open reduction and internal fixation,minimally invasive internal fixation under knee arthroscopy has advantages of less damage to the soft tissue and better knee function recovery.