关节镜辅助复位内固定治疗Schatzker Ⅰ~Ⅲ型胫骨平台骨折

Comparison of clinical efficacy between arthroscopy-assisted and open reduction and internal fixation in the treatment of Schatzker type I-III tibial plateau fractures

目的探讨关节镜辅助复位与切开复位内固定治疗SchatzkerⅠ~Ⅲ型胫骨平台骨折的临床疗效。方法回顾性分析2017年8月至2019年7月收治的SchatzkerⅠ~Ⅲ型胫骨平台骨折患者资料,根据治疗方法分为关节镜辅助复位内固定组(简称关节镜组)和切开复位内固定组(简称切开组)。关节镜组30例,男19例,女11例;年龄(45.13±7.12)岁(范围29~60岁);SchatzkerⅠ型13例,SchatzkerⅡ型14例,SchatzkerⅢ型3例。切开组30例,男17例,女13例;年龄(43.53±7.79)岁(范围31~58岁);SchatzkerⅠ型11例,SchatzkerⅡ型15例,SchatzkerⅢ型4例。记录手术时间、术中出血量、术后离床时间、术后完全负重时间及术后并发症。比较关节镜组和切开组术后膝关节肿胀程度、屈伸活动度和美国膝关节协会(American Knee Society,AKS)评分。结果两组患者均获得随访,关节镜组随访时间10~18个月,平均14个月;切开组12~18个月,平均15个月。关节镜组和切开组的手术时间[(87.60±9.20)min和(94.33±10.65)min]、术中出血量[(57.16±9.63)ml和(71.93±11.15)ml]、术后离床时间[(5.13±1.28)d和(6.17±1.53)d]及术后完全负重时间[(12.83±1.68)周和(14.23±1.77)周]比较差异均有统计学意义(t=2.62、5.49、2.83、3.94,P<0.05)。关节镜组术后骨折愈合时间为(13.33±1.37)周,切开组为(14.86±1.63周),差异有统计学意义(t=3.94,P<0.001)。术后1年,关节镜组膝关节屈伸活动度为116.77°±12.46°,大于切开组的109.13°±9.89°,差异有统计学意义(t=2.63,P=0.011);关节镜组AKS评分为(164.57±11.16)分,大于切开组的(149.53±14.77)分,差异有统计学意义(t=4.45,P<0.001)。两组均未发生畸形愈合及骨筋膜室综合征。关节镜组伤口愈合不良2例、膝关节活动度欠佳2例,并发症发生率为13%(4/30);切开组伤口愈合不良4例、伤口感染1例、膝关节活动度欠佳2例,并发症发生率为23%(7/30);两组并发症发生率的差异无统计学意义(χ^(2)=1.00,P=0.317)。结论关节镜辅助复位内固定治疗SchatzkerⅠ~Ⅲ型胫骨平台骨折具有创伤小、出血少、可早期活动、并发症少、膝关节活动度优等特点,且无明显的关节镜相关并发症,是一种安全可靠的治疗方法。

Objective To compare the clinical efficacy of arthroscopy-assisted and open reduction and internal fixation in the treatment of Schatzker type I-III tibial plateau fractures.Methods The data of patients with Schatzker type I-III tibial plateau fractures who were treated from August 2017 to July 2019 were retrospectively analyzed.According to the treatment,the patients were divided into the arthroscopic-assisted minimally invasive reduction and internal fixation group(arthroscopy group)and the conventional open reduction and internal fixation group(incision group).In the arthroscopy group,there were 30 patients,19 males and 11 females were included;the age was 45.13±7.12 years old(range,29-60 years).Among them,13 cases were Schatzker type I fractures,14 cases were Schatzker type II fractures,and 3 cases were Schatzker type III fractures.In the incision group,there were 30 patients,17 males and 13 females were included;the age was 43.53±7.79 years old(range,31-58 years).Among them,11 cases were Schatzker type I fractures,15 cases were Schatzker type II fractures,and 4 cases were Schatzker type III fractures.The operation time,intraoperative blood loss,postoperative ambulation time,postoperative complete weight-bearing time and postoperative complications were recorded.The degree of knee joint swelling,knee flexion and extension range of motion and the American knee society knee score(AKS score)were compared between the arthroscopy group and the incision group.Results Both groups were followed up.The follow-up time of the arthroscopy group were 10-18 months,with an average of 14 months;the follow-up time in the incision group were 12-18 months,with an average of 15 months.In the arthroscopy group,the operation time(87.60±9.20 min vs.94.33±10.65 min),intraoperative blood loss(57.16±9.63 ml vs.71.93±11.15 ml),postoperative ambulation time(5.13±1.28 d vs.6.17±1.53 d)and postoperative complete weight-bearing time(12.83±1.68 weeks vs.14.23±1.77 weeks)were superior to the incision group,and the differences were statistically significant(t=2.62,5.49,2.83,3.94;all P<0.05).The healing time was 13.33±1.37 weeks in the arthroscopy group and 14.86±1.63 weeks in the incision group,and the difference was statistically significant(t=3.94,P<0.001).At 1 year after surgery,the range of flexion and extension of knee joint in the arthroscopy group was 116.77°±12.46°,which was better than that in the incision group,which was 109.13°±9.89°,and the difference was statistically significant(t=2.63,P=0.011).The AKS score in the arthroscopy group was 164.57±11.16 points,and the score in the incision group was 149.53±14.77 points,and the difference was statistically significant(t=4.45,P<0.001).There were no malunion or compartment syndrome in the arthroscopy group and the incision group.The total incidence of complications in the arthroscopy group was 13%(4/30),including 2 cases of poor wound healing,2 of poor knee range of motion after operation.The total incidence of complications in the incision group was 23%(7/30),including 4 cases of poor wound healing,1 of wound infection,2 of poor knee range of motion after operation.And the difference between the two groups in complication incidence was not statistically significant(χ^(2)=1.00,P=0.317).Conclusion Arthroscopic-assisted reduction and internal fixation in the treatment of Schatzker I-III tibial plateau fractures has the advantages of less trauma,less bleeding,early mobility,fewer complications,and better knee joint function,and there are no obvious arthroscopic-related complications,which is a safe and reliable treatment method.