关节镜辅助微创治疗胫骨平台骨折的疗效观察

Effect of arthroscopic assisted minimally invasive treatment on tibial plateau fractures

目的观察在关节镜辅助下对胫骨平台骨折行微创复位和内固定的治疗效果。方法 2008-2012年北京医院(北京大学第五临床医学院)使用关节镜辅助微创治疗SchatzkerⅡ~Ⅵ型胫骨平台骨折15例,17个平台,其中男性10例12个平台,女性5例5个平台。年龄22~85(45.00±5.23)岁。致伤原因包括车祸、砸伤、滑雪扭伤及普通摔伤。骨折类型按Schatzker分型,Ⅱ型3例、Ⅲ型5例、Ⅳ型4例、Ⅴ型3例及Ⅵ型2例。手术时先镜下观察骨折复位情况,克氏针临时固定并复位其他骨折块,于平台外侧或内侧小切口置入解剖钢板并固定。术后早期康复锻炼,定期随访其功能和骨折愈合情况。结果 17个平台骨折手术均顺利完成,手术时间为60~90 min,其中关节镜检查时间10~15 min。骨折愈合时间为3~5个月,术后平均随访(26.8±4.1)个月,无下肢血栓、组织感染、骨筋膜室综合征等并发症。按照Lysholm膝关节评分标准,优13膝(76.5%),良3膝(17.6%),可1膝(5.9%),优良率达94.1%。结论关节镜辅助下微创治疗胫骨平台骨折创伤小、并发症少、疗效肯定,具有很好的临床应用价值,适用于SchatzkerⅡ~Ⅵ型胫骨平台骨折,但对手术技术要求较高。

Objective To observe the effect of minimally invasive reduction and internal fixation assisted by arthroscopy on tibial plateau fractures. Methods Fifteen cases（17 platforms） of Schatzker Ⅱ-Ⅵ tibial plateau fractures with minimally invasive treatment assisted by arthroscopy in Beijing Hospital and Hami Red Star Hospital from 2008 to 2012 were enrolled in our study. Of the 15 cases, there were 10 males（12 platforms） and 5 females（5 platforms）, with an average age of（45.00±5.23） years. Causes of injury included car accidents, bruises, ski sprains and normal falls. According to the Schatzker classification, there were 3 cases of type Ⅱ, 5 cases of type Ⅲ, 4 cases of type Ⅳ, 3 cases of type Ⅴ, and 2 cases of type Ⅵ. The outcome of fracture reduction was observed under the microscope. K-wires were used to fix and reposition fractures temporarily, then anatomical plates were implanted to fix the lateral or medial small incisions. Early postoperative rehabilitation exercises were done, and the fracture healing condition was followed up regularly. Results Surgeries were successfully performed on 17 platforms. The operating time was 60-90 minutes, and the time span of arthroscopy was about 10-15 minutes. The average follow-up time was（26.8±4.1） months, and the fracture healing time was 3-5 months. No complication such as lower limb thrombosis, tissue infection, and compartment syndrome was observed. According to the Lysholm knee score criteria, excellent therapeutic effect was achieved in 13 knees（76.5%）, good in 3 knees（17.6%）, and fare in 1 knee（5.9%）, with the excellent rate of 94.1%. Conclusion Arthroscopy assisted minimally invasive treatment for tibial plateau fractures has optimal curative effect with few complications and less-injury, which is worthy of clinical application. It is applicable to the Schatzker Ⅱ-Ⅵ type tibial plateau fractures, but it requires high surgical skills.