关节镜辅助下微创经皮闭合复位治疗非严重粉碎性髌骨骨折(骨折块≤3块)的效果

Effect of arthroscopic-assisted minimally invasive percutaneous closed reduction in the treatment of non-severely comminuted patellar fractures(fragments≤3 pieces)

目的探讨关节镜辅助下微创经皮闭合复位治疗非严重粉碎性髌骨骨折(骨折块≤3块)的效果。方法选取2014年5月至2018年5月大连市第五人民医院收治的56例非严重粉碎性髌骨骨折(骨折块≤3块)患者作为研究对象进行回顾性分析,按手术方法不同分将其为关节镜组(30例)和经皮组(26例)。关节镜组患者采用关节镜辅助下微创经皮闭合复位,经皮组患者采用透视下微创经皮闭合复位,两组患者均采用加压空心钉结合钛缆内固定。比较两组患者的手术时间、术中透视次数、术中出血量、切口长度、术后切口愈合时间、骨愈合时间;比较两组患者的术后并发症总发生率及术后合并症总发生率;依据美国纽约特种外科医院(HSS)膝关节评分,考察两组患者的术后膝关节功能优秀率及优良率。结果两组患者的手术时间、术中出血量、切口长度、术后切口愈合时间、骨愈合时间比较,差异无统计学意义(P>0.05);关节镜组患者的术中透视次数少于经皮组,差异有统计学意义(P<0.05);关节镜组患者的术后并发症总发生率及术后合并症总发生率均低于经皮组,差异有统计学意义(P<0.05);两组患者的膝关节功能优秀率、优良率比较,差异均无统计学意义(P>0.05)。结论关节镜辅助下微创经皮闭合复位和透视下微创经皮闭合复位这两种手术方式都能用于治疗非严重粉碎性髌骨骨折(骨折块≤3块),但是关节镜辅助下微创经皮闭合复位的术中透视次数更少,术后并发症及合并症发生率更低,临床推荐应用。

Objective To investigate the effect of arthroscopic-assisted minimally invasive percutaneous closed reduction in the treatment of non-severely comminuted patellar fractures(fragments≤3 pieces).Methods A total of 56 patients with non-severe comminuted patella fractures(fragments≤3 pieces)admitted to the Fifth People′s Hospital of Dalian City from May 2014 to May 2018 were selected as the research subjects for retrospective analysis.The patients were divided into an arthroscopic group(30 cases)and a percutaneous group(26 cases)based on different surgical methods.The patients in the arthroscopic group were treated with arthroscopic-assisted minimally invasive percutaneous closed reduction,and the patients in the percutaneous group were treated with minimally invasive percutaneous closed reduction under fluoroscope.They were both fixed with cannulated screws and titanium cable.The operation time,intraoperative fluoroscopic times,intraoperative blood loss,incision length,postoperative incision healing time,bone healing time were compared between the two groups.The total incidence of postoperative complications and the total incidence of postoperative comorbidity were compared between the two groups.According to the knee joint score of Hospital for Special Surgery in New York(HSS),the excellent rate and good rate of postoperative knee joint function in the two groups were investigated.Results There were no significant differences in operative time,intraoperative blood loss,incision length,postoperative incision healing time and bone healing time between the two groups(P>0.05).The number of intraoperative fluoroscopy in arthroscopy group was less than that in percutaneous group,and the difference was statistically significant(P<0.05).The total incidence rates of postoperative complications and postoperative comorbidity in arthroscopy group were lower than those in percutaneous group,with statistical significances(P<0.05).There were no significant differences in the excellent rate and good rate of knee function between the two groups(P>0.05).Conclusion Arthroscopic-assisted minimally invasive percutaneous closed reduction and minimally invasive percutaneous closed reduction under fluoroscope method can be used in the treatment of non-severely comminuted patellar fractures(fragments≤3 pieces),but arthroscopic-assisted minimally invasive percutaneous closed reduction has fewer intraoperative fluoroscopy times and lower incidence of postoperative complications and comorbidity,which is recommended for clinical application.