关节镜辅助下复位与传统切开复位钢板内固定治疗胫骨平台骨折疗效研究

Comparative study of arthroscopy assisted reduction and traditional open reduction plate internal fixation in the treatment of tibial plateau fracture

目的探讨关节镜辅助下复位与传统切开复位钢板内固定治疗胫骨平台骨折的临床疗效。方法回顾性分析自2015年3月至2017年3月收治的70例胫骨平台新鲜骨折患者的临床资料,分为A组(n=35)与B组(n=35)。其中,A组患者采用传统切开复位钢板内固定治疗,B组患者采用关节镜辅助下经皮钢板内固定治疗。记录两组患者手术指标、术后并发症发生情况,并于术后采用美国特种外科医院膝关节评分评估患者膝关节功能,评价治疗效果。结果B组患者手术时间、切口长度均短于A组,术中出血量少于A组,差异均有统计学意义(P<0.05)。A组患者术后出现关节僵直2例(5.7%),畸形愈合1例(2.9%),创伤性关节炎4例(11.4%);B组患者术后出现创伤性关节炎1例(2.9%)。B组患者术后并发症发生率为2.9%(1/35),明显低于A组的20.0%(7/35),差异有统计学意义(P<0.05)。B组患者治疗后优良率为80.0%(28/35),明显高于A组的57.1%(20/35),差异有统计学意义(P<0.05)。结论关节镜辅助下复位钢板内固定治疗胫骨平台骨折,手术时间、切口长度较短,术中出血量较少,且术后并发症发生率低,临床疗效较好。

Objective To investigate the clinical effect of arthroscopy assisted reduction and traditional open reduction plate internal fixation in the treatment of tibial plateau fracture. Methods A retrospective study was performed on 70 cases of patients with fresh tibial plateau fracture who were admitted from March 2015 to March 2017.Patients were divided into the Group A( n =35)and Group B ( n =35).Among them,patients in Group A were treated with traditional open reduction plate internal fixation,while patients in Group B were treated with arthroscopy assisted percutaneous plate internal fixation.Surgical indicators and postoperative complications of the two groups were recorded,and the knee function of the patients was assessed by the knee joint score of the hospital for special surgery(HSS) in the United States,and the therapeutic effect was evaluated. Results The operative time and incision length of patients in Group B were shorter than those in Group A,and the intraoperative blood loss was less than that in Group A,with statistically significant differences ( P < 0.05).In Group A,2 patients(5.7%)developed joint rigor after surgery,1 patient(2.9%)had malunion,and 4 patients(11.4%)had traumatic arthritis.Postoperative traumatic arthritis occurred in 1 patient(2.9%)in Group B.The incidence of postoperative complications in Group B was 2.9%(1/35),which was significantly lower than 20.0%(7/35)in Group A( P <0.05).The excellent and good rate of Group B was 80.0%(28/35)after treatment,significantly higher than 57.1%(20/35)of Group A( P <0.05). Conclusion Arthroscopy assisted reduction and plate internal fixation for tibial plateau fracture resulted in shorter operative time,shorter incision length,less intraoperative blood loss,lower incidence of postoperative complications and better clinical efficacy.