关节镜辅助经皮内固定和切开复位内固定治疗Schatzker Ⅱ、Ⅲ型胫骨平台骨折的疗效

Arthroscopic assisted percutaneous fixation versus open reduction internal fixation for the treatment of Schatzker Ⅱ/Ⅲ tibial plateau fractures

目的对比分析关节镜辅助经皮内固定和切开复位内固定治疗Schatzker Ⅱ、Ⅲ型胫骨平台骨折的疗效差异。方法回顾性分析2013年1月至2016年1月期间共收治Schatzker Ⅱ、Ⅲ型胫骨平台骨折患者68例资料,根据手术方法将其分成两组,其中40例选用关节镜辅助经皮内固定治疗者为观察组,28例选用切开复位内固定治疗者为对照组。分析对比两组患者各手术指标、临床治疗效果、术后并发症情况。结果观察组患者手术时间(53. 75±5. 64) min、术中出血量(59. 45±5. 38) ml、切口大小(6. 17±0. 65) cm、术后离床时间(3. 35±0. 46) d、术后完全负重时间(3. 62±0. 38)月、骨折愈合时间(3. 44±0. 40)月,与对照组[(89. 57±8. 56) min、(108. 22±9. 54) ml、(17. 72±1. 87) cm、(5. 36±0. 47) d、(4. 87±0. 42)月、(4. 65±0. 52)月]比较均明显减少(P <0. 05),关节活动度(123. 35±6. 86)°、HSS评分(107. 20±6. 43)分与对照组[(111. 86±5. 65)°、(82. 34±5. 23)分]比较均明显增加(P <0. 05)。观察组治疗优良率为90. 00%,与对照组(71. 43%)比较明显提高(P <0. 05)。观察组术后并发症发生率为12. 50%,与对照组(32. 14%)比较明显降低(P <0. 05)。结论关节镜辅助经皮内固定治疗SchatzkerⅡ、Ⅲ型胫骨平台骨折创伤小、复位好、恢复快、并发症少,安全、可靠,可作为临床治疗首选,但对手术要求高,且要充分考虑手术禁忌证选择应用。

Objective To compare the efficacy of arthroscopic-assisted percutaneous fixation and open reduction internal fixation in the treatment of tibial plateau fractures of Schatzker Ⅱ and Ⅲ.Methods 68 patients of Schatzker Ⅱ/Ⅲ tibial plateau fractures from January 2013 and January 2016 were retrospectively randomized into two groups,namely observation group with arthroscopy(n=40)and control group with ORIF(n=28).The clinical outcomes of the two groups of patients were analyzed and compared.Results For the observation group,the operation time(53.75±5.64)min,blood loss(59.45±5.38)ml,incision size(6.17±0.65)cm,postoperative bed rest(3.35±0.46)d,postoperative full weight-bearing(3.62±0.38)mo,and the healing time(3.44±0.40)mo were significantly reduced compared with control[(89.57±8.56)min,(108.22±9.54)ml,(17.72±1.87)cm,(5.36±0.47)d,(4.87±0.42)mo,(4.65±0.52)mo,P<0.05].The joint range of motion(123.35±6.86)°,HSS score(107.20±6.43)were significantly increased than control[(111.86±5.65)°,(82.34±5.23)scores,P<0.05].90%of the observation group was scored excellent to satisfactory,which was higher than control(71.43%,P<0.05).The incidence of postoperative complications in the observation group was 12.50%,which was significantly lower than control(32.14%,P<0.05).Conclusion Arthroscopic-assisted percutaneous fixation has an edge over ORIF in the treatment of Schatzker type tibial plateau fracture for its less incision,quick recovery,fewer complications,higher safety and reliability.