切开复位内固定与关节镜辅助下经皮撬拨复位空心钉内固定在胫骨平台骨折治疗中的应用观察

Application of open reduction and internal fixation and arthroscopic assisted percutaneous leverage reduction and hollow screw internal fixation in treatment of tibial plateau fractures

目的观察切开复位内固定与关节镜辅助下经皮撬拨复位空心钉内固定在胫骨平台骨折治疗中的应用效果。方法选取在开封市人民医院进行治疗的97例胫骨平台骨折的患者作为研究对象,将患者随机分组,其中观察组49例,对照组48例,观察组在关节镜辅助下经皮撬拨复位以空心钉进行固定,对照组使用切开复位内固定。比较两组的手术疗效、临床指标及术后并发症,将两组患者手术前与手术后6个月的膝关节功能与活动度进行对比。结果观察组术后膝关节功能优良率高于对照组(P<0.05);手术后6个月观察组患者的膝关节功能评分(HSS)评分高于对照组,膝关节活动度大于对照组(P<0.05);观察组患者的手术时间、住院时间及骨折愈合时间均短于对照组(P<0.05),术中出血量少于对照组(P<0.05),切口长度短于对照组(P<0.05);观察组术后并发症发生率较对照组低(P<0.05)。结论在关节镜辅助下经皮撬拨复位骨折的胫骨平台并以空心钉进行固定的手术治疗效果显著,与传统的切开复位内固定相比,关节镜下手术治疗的手术时间短,术中出血少,术后恢复快,患者膝关节功能恢复较好,术后并发症发生率低。

【Objective】 To observe the application effect of open reduction and internal fixation and arthroscopic assisted percutaneous leverage reduction and hollow screw internal fixation in the treatment of tibial plateau fractures.【Methods】 Totally97 patients with tibial plateau fractures treated in our hospital were selected as the research subjects,and the patients were randomly grouped,including 49 cases in observation group and 48 cases in control group.Observation group was given arthroscopic assisted percutaneous leverage reduction using hollow screws for fixation,and control group applied open reduction and internal fixation.The surgical efficacy,clinical indicators and postoperative complications of the two groups were compared,and the knee joint function and range of motion were compared between the two groups of patients before surgery and 6 months after surgery.【Results】 The excellent and good rate of knee joint function in observation group after surgery was higher than that in control group(P<0.05).The hospital for special surgery(HSS) knee joint score of observation group was higher than that of control group 6 months after surgery,and the range of motion of knee joint of observation group was greater than that of control group(P<0.05).The surgical time,hospital stay and fracture healing time were shorter in observation group than those in control group(P<0.05),and the intraoperative blood loss was less in observation group than in control group(P<0.05),and the incision length was shorter in observation group than in control group(P<0.05).The incidence rates of postoperative complications of observation group were lower than those of control group(P<0.05).【Conclusion】 Arthroscopic assisted percutaneous leverage reduction for fracture of tibial plateau and hollow screws for fixation can have a significant surgical treatment effect.Compared to traditional open reduction and internal fixation,arthroscopic surgery has shorter surgical time,less intraoperative blood loss,faster postoperative recovery,better recovery of knee joint function and lower incidence rates of postoperative complications.