关节镜结合MIPPO技术治疗Schatzker Ⅳ型胫骨平台骨折

Treatment of Schatzker Ⅳ tibial plateau fractures with arthroscopy combined with MIPPO technique

目的 :探讨关节镜结合微创经皮钢板内固定(minimally invasive percutaneous plate osteosynthesis,MIPPO)技术治疗SchatzkerⅣ型胫骨平台骨折的临床效果。方法:2012年1月至2016年1月采用关节镜结合MIPPO技术治疗19例SchatzkerⅣ型胫骨平台骨折,男12例,女7例;年龄19~78岁,平均46.5岁;术前均有膝关节疼痛、肿胀、屈伸受限等症状,术后对患者进行随访,采用Rasmussen进行膝关节功能评分。结果:术后无感染、创伤性关节炎、膝关节内外翻畸形等并发症。19例均获得随访,时间12~24个月,平均18.6个月;骨折愈合时间3~5个月,平均3.8个月;患者膝关节肿痛及活动受限情况明显改善,关节自主活动范围90°~136°。Rasmussen功能总分27.00±2.49;优16例,良2例,可1例。结论 :关节镜结合MIPPO技术治疗SchatzkerⅣ型胫骨平台骨折,可同时处理半月板等膝关节内部结构损伤,创伤小,并发症少,关节功能恢复快,但要严格掌握手术适应证,避免扩大损伤。

Objective：To discusses the clinical effects of arthroscopy combined with minimally invasive percutaneous plate osteosynthesis（MIPPO） technology in treating Schatzker Ⅳ tibial plateau fractures. Methods：From January 2012 to January 2016,19 patients with Schatzker type Ⅳ tibial plateau fractures were treated with arthroscopy combined with minimally invasive technique including 12 males and 7 females with an average age of 46.5 years old ranging from 19 to 78 years old. Patients were suffering knee pain,swelling,flexion and extension limited,and other symptoms preoperative. Patients were followed up and assessed by Rasmussen knee function score. Results：No infection,traumatic arthritis,and knee joint valgus occurred after operation. Nineteen cases were followed up for 12 to 24 months with an average of 18.6 months. Fracture healing time was 3 to 5 months with an average of 3.8 months. The knee pain and limited mobility improved significantly. The range of autonomic movement of joints was from 90 to 136 degrees. According to Rasmussen functional score criteria,the total score was 27.00±2.49,the result was excellent in 16 cases,good in 2 cases,fair in 1 case. Conclusion：Arthroscopic treatment for Schatzker type Ⅳ tibial plateau fractures combined with MIPPO can simultaneously treat internal structural injuries such as meniscus and other knee joints,with less trauma,fewer complications,and faster joint function recovery,but we must strictly grasp surgical indications and avoid expanding injuries.