关节镜辅助复位内固定与切开复位内固定治疗胫骨平台骨折的疗效比较

Comparison of arthroscopy-assisted reduction and internal fixation versus open reduction and internal fixation for tibial plateau fractures

目的比较关节镜辅助复位内固定(ARIF)和切开复位内固定(ORIF)治疗胫骨平台骨折的疗效。方法回顾性分析2016年1月至2018年8月华中科技大学附属协和医院骨科收治的75例胫骨平台骨折患者的资料。男58例,女17例;年龄20~54岁,平均47岁。左侧42例,右侧33例。骨折根据Schatzker分型:Ⅰ型23例,Ⅱ型49例,Ⅲ型3例。患者按治疗方案不同分为2组:ARIF组(采用ARIF治疗40例),ORIF组(采用ORIF治疗35例)。记录并比较两组患者的手术时间、切口长度、术中出血量、住院时间、术后并发症情况及术后12个月美国特种外科医院(HSS)膝关节功能评分。结果ARIF组和ORIF组患者的术前一般资料比较差异均无统计学意义(P>0.05),具有可比性。所有患者术后获12~15个月(平均13.5个月)随访。75例患者伤口均一期愈合,无神经、血管损伤等相关并发症。术后6个月所有患者骨折均获愈合。ARIF组的手术时间[(58.3±4.2)min]较ORIF组[(48.4±5.2)min]长,ARIF组的切口长度[(4.3±0.9)cm]较ORIF组[(6.2±0.8)cm]短,ARIF组术中失血量[(60.8±4.5)mL]较ORIF组[(72.8±6.5)mL]少,差异均有统计学意义(P<0.05)。ARIF组和ORIF组住院时间分别为(5.1±0.6)、(5.5±1.6)d,差异无统计学意义(P>0.05)。ARIF组和ORIF组分别有15例和5例患者合并软组织损伤,差异有统计学意义(P<0.05)。术后12个月ARIF组和ORIF组患者的HSS评分优良率分别为100%(40/40)和85%(34/40),差异无统计学意义(P>0.05)。结论ARIF和ORIF治疗SchatzkerⅠ~Ⅲ型胫骨平台骨折均可以获得良好疗效;但ARIF可以更准确地评估和治疗胫骨平台骨折合并的膝关节软组织损伤,具有手术时间短、切口小、出血少的特点。

Objective To compare the efficacy between arthroscopy-assisted reduction and internal fixation(ARIF)versus open reduction and internal fixation(ORIF)in the treatment of tibial plateau fractures.Methods A retrospective analysis was done of the 75 patients with tibial plateau fracture who had been treated by ARIF or ORIF at Department of Orthopaedics,Union Hospital Affiliated to Tongji Medical Collage from January 2016 to August 2018.They were 58 men and 17 women,aged from 20 to 54 years(average,47 years).The left side was affected in 42 cases and the right side in 33.By the Schatzker classification,there were 23 cases of typeⅠ,49 cases of typeⅡand 3 cases of typeⅢ.Of them,40 were treated by ARIF and 35 by ORIF.The 2 groups were compared in terms of operation time,incision length,intraoperative blood loss,hospital stay,postoperative complications and the Hospital for Special Surgery(HSS)scores 12 months after operation.Results There was no statistically significant difference between the 2 groups in the preoperative general data,showing the 2 groups were comparable(P>0.05).The patients were followed up for 12 to 15 months(average,13.5 months)after operation.The wounds in the 75 patients healed at one stage with no complications like neurovascular lesions.All the fractures healed within 6 months after operation.Compared with the ORIF group,the ARIF group had significantly longer operation time(58.3 min±4.2 min versus 48.4 min±5.2 min),a significantly shorter incision(4.3 cm±0.9 cm versus 6.2 cm±0.8 cm),and significantly less intraoperative blood loss(60.8 mL±4.5 mL versus 72.8 mL±6.5 mL)(P<0.05).There was no significant difference between the 2 groups in hospital stay(5.1 d±0.6 d versus 5.5 d±1.6 d)(P>0.05).Fifteen patients in the ARIF group and 5 in the ORIF group were complicated with soft tissue injury,showing a statistically significant difference(P<0.05).The excellent and good rate by HSS scores was 100%(40/40)for the ARIF group and 85%(34/40)for the ORIF group,showing no significant difference(P>0.05).Conclusions In the treatment of tibial plateau fractures of Schatzker typesⅠ-Ⅲ,both ARIF and ORIF may result in good efficacy.However,ARIF can evaluate and treat the complicated soft tissue injuries to the knee joint more precisely,showing advantages of shorter operation time,a smaller incision and less blood loss.