关节镜下利用纳米羟基磷灰石棒治疗SchatzkerⅢ型胫骨平台骨折:6个月随访

Arthroscopic treatment of Schatzker type Ⅲ tibial plateau fractures with hydroxylapatite rods: 6-month follow-up

背景:单纯的SchatzkerⅢ型胫骨平台骨折临床治疗方法不统一,有内固定、外固定及关节镜等治疗方法。目的:探讨关节镜下纳米羟基磷灰石棒植入治疗SchatzkerⅢ型胫骨平台骨折的疗效及影响因素分析。方法:纳入河北省人民医院2017年7月至2019年7月收治的36例SchatzkerⅢ型胫骨平台骨折患者,男25例,女11例,年龄20-57岁,其中观察组18例接受关节镜下纳米羟基磷灰石棒植入微创治疗,对照组18例接受传统切开接骨板螺钉内固定治疗。术后随访6个月,记录并发症发生情况与骨折愈合时间,采用目测类比评分评估疼痛情况,HSS膝关节功能评分评估膝关节功能,Lysholm膝关节评分评估治疗优良率。单因素分析观察组患者年龄、性别、有合并半月板及韧带损伤、手术时间及术中出血量等各单因素对术后膝关节疗效的影响。试验获得河北省人民医院伦理委员会批准。结果与结论:①观察组术后下肢深静脉血栓、创伤性关节炎等并发症发病率低于对照组(P <0.05);②观察组骨折愈合时间短于对照组(P <0.05),临床治疗优良率高于对照组(P <0.05);③观察组术后第1天、1周及1,3个月的目测类比评分均低于对照组(P <0.05),术后1,3,6个月的HSS膝关节功能评分均高于对照组(P <0.05);④单因素分析显示,年龄<50岁患者术后疗效优于≥50岁患者(P <0.05);⑤结果表明,关节镜下纳米羟基磷灰石棒植入微创治疗SchatzkerⅢ型胫骨平台骨折可促进骨折愈合,减轻疼痛,促进关节功能恢复,其中年龄是影响术后疗效的独立因素。

BACKGROUND: The clinical treatment of Schatzker III tibial plateau fracture is different, including internal fixation, external fixation and arthroscopy.OBJECTIVE: To investigate the effect and influencing factors of arthroscopic treatment of Schatzker type III tibial plateau fracture with nano hydroxylapatite rod.METHODS: Totally 36 cases of Schatzker type III tibial plateau fractures admitted to Hebei Provincial People’s Hospital from July 2017 to July 2019 were enrolled, including 25 males and 11 females, aged 20-57 years. Among them, 18 patients in the observation group received minimally invasive arthroscopic hydroxylapatite rod implantation and 18 patients in the control group received conventional open plate and screw fixation. After 6 months of follow-up, complications and fracture healing time were recorded. Pain was assessed by visual analogue scale score. Knee function was assessed by HSS score. Excellent and good rate was assessed by Lysholm score. The effects of single factors such as age, sex, combined meniscus and ligament injuries, operation time and intraoperative blood loss in the observation group on the efficacy of the postoperative knee joint were analyzed by single factor analysis. The trial was approved by the Ethics Committee of Hebei Provincial People’s Hospital. RESULTS AND CONCLUSION:(1) The incidence rate of postoperative complications such as deep venous thrombosis and traumatic arthritis in the observation group was lower than that in the control group(P < 0.05).(2) The healing time of the observation group was shorter than that of the control group(P < 0.05). The excellent and good rate of clinical treatment was higher in the observation group than that of the control group(P < 0.05).(3) The visual analogue scale scores of the observation group were lower than those of the control group at 1 day, 1 week, 1 and 3 months after operation(P < 0.05). The HSS scores of knee joint function in 1, 3 and 6 months after operation were higher in the observation group than those in the control group(P < 0.05).(4) The single factor analysis showed that the postoperative effect of patients with age < 50 years was better than that of patients with age ≥ 50 years(P < 0.05).(5) The results showed that the minimally invasive treatment of Schatzker type III tibial plateau fracture with nano hydroxyapatite rod under arthroscope could promote fracture healing, alleviate pain and promote joint function recovery, in which the age was an independent factor affecting the postoperative effect.