关节镜辅助经皮钢板固定胫骨平台骨折

Percutaneous plate osteosynthesis under arthroscopic assistance for tibial plateau fractures

[目的]通过与常规开放复位钢板内固定比较,评价关节镜辅助微创经皮钢板内固定术(minimally invasive percutaneous plate osteosynthesis, MIPPO)治疗SchatzkerⅡ、Ⅲ型胫骨平台骨折的疗效。[方法] 2016年1月~2019年12月,对120例SchatzkerⅡ、Ⅲ型胫骨平台骨折患者行手术治疗。其中,60例采用关节镜辅助MIPPO治疗,60例采用常规ORIF治疗。比较两组临床资料、实验室检测应激指标和血清炎性因子。[结果]所有患者均顺利完成手术,MIPPO组手术时间、术中出血量、住院时间显著优于ORIF组。两组患者随访6~18个月,平均(12.12±1.57)个月。MIPPO组下地行走时间和完全负重活动时间均显著早于ORIF组(P<0.05)。末次随访时,MIPPO活动时间VAS评分、HSS评分和膝伸屈ROM均显著优于ORIF组(P<0.05)。总并发症率MIPPO组为1.67%,ORIF组为11.67%,两组间差异具有统计学意义(P<0.05)。实验室检测方面,相较于术前1 d,术后7 d时两组患者SP、PGE2、NPY、CRP、IL-1β和IL-8均显著增加(P<0.05)。术前1 d两组间上述指标的差异均无统计学意义(P>0.05),但是,术后7 d时,MIPPO组各指标水平均显著低于ORIF组(P<0.05)。[结论]关节镜辅助MIPPO治疗胫骨平台骨折,显著减轻了医源性损伤,表现为应激反应和炎性反应显著减轻,并取得更好的临床结果。

[Objective] To evaluate the clinical outcomes of minimally invasive percutaneous plate osteosynthesis(MIPPO)under arthroscopic assistance for Schatzker type Ⅱ and Ⅲ tibial plateau fractures by comparision with conventional open reduction and internal fixation with plate(ORIF). [Methods] From January 2016 to December 2019, a total of 120 patients underwent surgical treatments in our hospital for Schatzker type Ⅱ and Ⅲ tibial plateau fractures. Of them, 60 patients received MIPPO under arthroscopic assistance, while the remaining 60 patients had conventional ORIF performed. The clinical documents and laboratory tests involving stress reaction and inflammatory factors were compared between the two groups. [Results] All patients in both groups had operation finished successfully. The MIPPO group was significantly superior to the ORIF group in operation time, intraoperative blood loss and hospital stay(P<0.05). The follow-up period lasted for 6~18 months with an average of(12.12±1.57) months. The MIPPO group returned to ambulation and full-weight bearing activity significantly earlier than the ORIF group(P<0.05). At the latest follow-up, the MIPPO group proved significantly superior to the ORIF group regarding to VAS score in activity, HSS score and flexion-extension ROM(P<0.05). The total complication rate was 1.67% in the MIPPO group, whereas 11.67% in the ORIF group, which was of statistical significance(P<0.05). In term of laboratory test, the SP,PGE2, NPY, CRP, IL-1β and IL-8 significantly increased at 7 days postoperatively compared with those at 1 day before operation in both groups(P<0.05). Although no statistical difference was noticed between the two groups in any of aforesaid parameters before operation, the MIPPO group had significantly lower level of SP, PGE2, NPY, CRP, IL-1β and IL-8 than the ORIF group at 7 days after operation(P<0.05). [Conclusion] The MIPPO under arthroscopic assistance does reduce iatrogenic trauma, which presents decline of stress and inflammatory reactions, and achieve improved clinical outcomes for tibial plateau fractures.