关节镜辅助下锁定空心螺钉固定与切开复位钢板内固定治疗SchatzkerⅡ-Ⅲ型胫骨平台骨折的早期CT评价

Arthroscopy-assisted locking hollow screw fixation and open reduction plate internal fixation in the treatment of SchatzkerⅡ-Ⅲtibial plateau fractures:early CT evaluation

背景:SchatzkerⅡ-Ⅲ型胫骨平台骨折是临床上常见的骨折之一,传统的切开复位内固定会造成很大的手术创伤,常对患者造成很大困扰。目的:探讨关节镜辅助下锁定空心螺钉治疗SchatzkerⅡ-Ⅲ型胫骨平台骨折与传统的切开复位钢板内固定治疗SchatzkerⅡ-Ⅲ型胫骨平台早期的影像学结果及临床结果。方法:回顾性收集2015-01-01/2020-01-01于成都市青白江区人民医院行手术治疗且满足标准的SchatzkerⅡ-Ⅲ型胫骨平台骨折患者118例,随机分为2组,锁定空心螺钉组52例采用关节镜辅助下锁定空心螺钉固定治疗;传统组66例采用切开复位钢板内固定治疗。记录并比较两组患者术中失血量、切口长度、花费、住院时间,术前、术后1 d、术后1周评估目测类比疼痛评分,术前、术后1 d CT扫描膝关节并记录胫骨平台关节面最大的沉降距离,记录末次随访(术后2年)膝关节活动度、膝关节美国特种外科医院评分、美国膝关节协会临床、功能评分以及并发症发生情况。结果与结论:(1)锁定空心螺钉组手术失血量、切口长度、花费、住院时间均优于传统组,差异有显著性意义(P<0.05);传统组手术时间短于锁定空心螺钉组(P<0.05);(2)两组患者术前及术后1周目测类比评分相比,差异无显著性意义(P>0.05);在术后1 d时,锁定空心螺钉组目测类比评分低于传统组(P<0.05);(3)两组患者术前CT测量骨折分离距离相比,差异无显著性意义(P>0.05);术后1 d时,锁定空心螺钉组骨折分离距离小于传统组(P<0.05);(4)术后2年时,锁定空心螺钉组膝关节屈曲度大于传统组,差异有显著性意义(P<0.05);两组患者膝关节伸直度、美国特种外科医院评分、美国膝关节协会临床及功能评分相比,差异无显著性意义(P>0.05);(5)提示关节镜辅助下锁定空心螺钉固定治疗SchatzkerⅡ-Ⅲ型胫骨平台骨折与切开复位内固定相比,在失血量、切口长度、疼痛、花费、住院时间、复位程度上具有优越性,但在膝关节功能评分上无明显差别且手术时间较长。

BACKGROUND:SchatzkerⅡ-Ⅲtibial plateau fractures are one of the most common fractures in clinical practice.The traditional open reduction and internal fixation scheme can cause great surgical trauma,often causing great troubles to clinicians and patients.OBJECTIVE:To discuss the early imaging and clinical results of the treatment of SchatzkerⅡ-Ⅲtibial plateau fractures with arthroscopy-assisted locking hollow screws and traditional open reduction plate internal fixation.METHODS:118 patients with SchatzkerⅡ-Ⅲtibial plateau fractures who met the criteria for surgical treatment in Qingbaijiang District People s Hospital of Chengdu from January 1,2015 to January 1,2020 were retrospectively collected and randomly assigned to two groups.The 52 cases of the locking hollow screw group were treated with locking hollow screw fixation assisted by arthroscopy.The 66 cases of the traditional group were treated with open reduction steel plate internal fixation.The intraoperative blood loss,incision length,cost,length of hos pital stay,and visual analogue scale pain score before operation,1 day and 1 week after operation were recorded and compared between the two groups.Before and 1 day after the operation,the knee joint was scanned by CT to record the maximum settlement distance of the tibial plateau articular surface.Range of motion,Hos pital for Special Surgery knee score,Knee Society Score(clinical sco re and functional score),and complications during the last follow-up(2 years after surge ry)we re recorded.RESULTS AND CONCLUSION:(1)The intraoperative blood loss,incision length,cost,and length of hos pital stay were significantly better in the locking hollow screw group than those in the traditional group(P<0.05).The surgical time in the traditional group was significantly shorter than that in the locking hollow screw group(P<0.05).(2)There was no significant difference in visual analogue scale scores between the two groups before and 1 week after surgery(P>0.05).At 1 day after surgery,the visual analogue scale score of the locking hollow screw group was significantly shorter than that of the tra ditional group(P<0.05).(3)There was no significant difference in the fracture separation distance measured by CT befo re operation between the two groups(P>0.05).At 1 day after ope ration,the fracture separation distance in the locking hollow screw group was significantly lower than that in the traditional group(P<0.05).(4)At 2 years postoperatively,the range of flexion in the locking hollow screw group was significantly higher than that in the traditional group(P<0.05).There was no significant difference in range of knee extension,hospital for special surgery knee score,and Knee Society Score(clinical score and functional score)between the two groups(P>0.05).(5)It is indicated that compared with open reduction and internal fixation,arthroscopy-assisted locking hollow screw fixation in the treatment of SchatzkerⅡ-Ⅲtibial plateau fractures has advantages in blood loss,incision length,pain,cost,hospital stay,and degree of reduction.However,there was no significant difference in functional sco re and the operation time was longer.