镜下经皮与开放复位内固定SchatzkerⅢ型胫骨平台骨折

Arthroscopic reduction and percutaneous internal fixation versus open reduction and internal fixation for Schatzker type Ⅲ tibial plateau fractures

[目的]比较镜下复位经皮固定与常规开放复位内固定治疗SchatzkerⅢ型胫骨平台骨折的疗效。[方法]2017年12月一2019年10月收治的SchatzkerⅢ型胫骨平台骨折患者88例,其中,22例采用镜下复位经皮内固定治疗,66例采用常规切开复位内固定。比较两组患者的围术期资料及随访结果。[结果]镜下组手术时间、切口长度、术中出血量、术后引流量、术后下地时间和住院时间均显著优于开放组(P<0.05)。总并发症率,镜下组为1/22(4.55%),开放组为16/66(24.24%),差异有统计学意义(P<0.05)。随术后时间推移,两组患者VAS评分均显著减少(P<0.05),而ROM和HSS评分均显著增加(P<0.05)。术后1个月镜下组的VAS评分、ROM与HSS评分均显著优于开放组(P<0.05)。影像方面,相应时间点,两组间的TPA和PTS的差异均无统计学意义(P>0.05)。术后影像显示,两组间关节面复位质量差异无统计学意义(P>0.05)。镜下组骨折愈合时间显著早于开放组(P<0.05)。[结论]镜下复位经皮内固定治疗SchatzkerⅢ型胫骨平台骨折的临床效果优于切开复位内固定。

[Objective]To compare the clinical outcomes of arthroscopic reduction and percutaneous internal fixation versus conventional open reduction and internal fixation for Schatzker type Ⅲ tibial plateau fractures.[Methods]From December 2017 to October 2019,a total of 88 patients underwent surgical treatment for Schatzker type Ⅲ tibial plateau fractures in our hospital.Among them,22 patients were treated with arthroscopic reduction and percutaneous internal fixation,while 66 patients underwent conventional open reduction and internal fixation.The perioperative,follow-up and radiographic documents were compared between the two groups.[Results]The arthroscopic group proved significantly superior to the open group in terms of operation time,incision length,intraoperative blood loss,postoperative drainage volume,the time to get out of bed and hospital stay(P<0.05).The total complication rate was 1/22(4.55%)in the arthroscopic group,whereas 16/66(24.24%)in the open group,which was statistically significant(P<0.05).The VAS scores decreased significantly(P<0.05),whereas the ROM and HSS scores increased significantly over time in both groups(P<0.05).At 1 month after operation,the arthroscopic group was significantly superior to the open group in terms of VAS score,ROM and HSS scores(P<0.05).With respect of imaging evaluation,there were no statistical differences in tibial plateaus angle(TPA)and posterior tibial slope(PTS)at any corresponding time point between the two groups.In addition,there was no a statistical difference in the quality of articular surface reduction between the two groups(P>0.05).However,the arthroscopic group achieved fracture healing significantly earlier than the open group(P<0.05).[Conclusion]The arthroscopic reduction and percutaneous internal fixation do achieve considerably better clinical results for Schatzker type Ⅲ tibial plateau fractures in comparison with the conventional open reduction and internal fixation.