关节镜下植骨融合联合内固定术治疗胫骨平台粉碎性骨折的临床研究

A clinical study on the treatment of comminuted tibial plateau fracture by arthroscopic bone graft fusion and internal fixation

目的观察关节镜下植骨融合联合内固定术治疗胫骨平台粉碎性骨折的临床效果。方法选择2018年8月至2019年8月,入我院就诊的84例胫骨平台粉碎性骨折患者,采用随机数字法分为对照组和观察组,每组各42例。对照组采用关节镜下钢板内固定术,观察组在此基础上进行植骨融合。比较两组骨折愈合时间和完全负重时间,胫骨平台内翻角和后倾角,膝关节美国特种外科医院(Hospital for special surgery,HSS)评分及优良率,随访并发症并计算发生率。结果观察组患者骨折愈合时间[(7.6±0.9)天vs.(10.8±1.3)天]和完全负重时间[(8.2±1.3)天vs.(11.4±1.8)天]较对照组患者缩短,差异有统计学意义(P<0.05)。观察组患者术后1个月、6个月内翻角[(83.1±1.3)°vs.(85.6±1.6)°,(82.5±1.1)°vs.(84.2±1.3)°]和后倾角[(10.9±0.4)°vs.(12.3±0.5)°,(10.3±0.3)°vs.(12.1±0.4)°]小于对照组患者,差异有统计学意义(P<0.05)。观察组患者HSS评分总分[(83.6±5.4)分vs.(72.6±4.9)分]及优良率(88.1%vs.69.0%)高于对照组,随访并发症发生率(7.2%vs.23.8%)低于对照组患者,差异均有统计学意义(P<0.05)。结论关节镜下植骨融合联合内固定术较单纯关节镜下钢板内固定术治疗胫骨平台粉碎性骨折具有更好的临床优势,能够缩短骨折愈合和负重时间,增加胫骨平台稳定性,改善膝关节功能以及降低并发症。

Objective To observe the clinical effect of bone graft fusion combined with internal fixation under arthroscopy in treatment of comminuted tibial plateau fractures.Methods A total of 84 patients with comminuted tibial plateau fracture,admitted to our hospital from August 2018 to August 2019,were selected and divided into control group and observation group by random number method,with 42 patients in each group.The control group underwent arthroscopic plate internal fixation,and the observation group underwent bone grafting and fusion on this basis.Fracture healing time,full weight bearing time,tibial plateau varus angle and posterior inclination angle,Hospital for Special Surgery(HSS)score,excellent and good rate,and incidence of complications in follow-up were compared between the two groups.Results The fracture healing time[(7.6±0.9)d vs.(10.8±1.3)d]and full weight bearing time[(8.2±1.3)d vs.(11.4±1.8)d]of the observation group were shorter than those of the control group(P<0.05).The varus angle[(83.1±1.3)°vs.(85.6±1.6)°,(82.5±1.1)°vs.(84.2±1.3)°],posterior inclination angle[(10.9±0.4)°vs.(12.3±0.5)°,(10.3±0.3)°vs.(12.1±0.4)°]and incidence of follow-up complications(7.2%vs.23.8%)of the observation group were significantly lower than that of the control group 1 month and6 months after surgery(P<0.05),while the total HSS score[(83.6±5.4)min vs.(72.6±4.9)min]and the excellent and good rate(88.1%vs.69.0%)in the observation group were higher(P<0.05).Conclusions Arthroscopic bone grafting combined with internal fixation has clinical advantages than arthroscopic plate internal fixation in the treatment of comminuted fractures of the tibial plateau,which can shorten fracture healing time and full weight bearing time,increase the stability of the tibial plateau,improve knee functions and reduce complications.