关节镜辅助下微创经皮钢板固定技术治疗Schatzker Ⅰ~Ⅲ型胫骨平台骨折伴韧带损伤51例

Minimally invasive percutaneous plate fixation with arthroscopic assistance in the treatment of 51 cases of Schatzker type Ⅰ~Ⅲ tibial plateau fracture with ligament injury

目的探讨关节镜辅助下微创经皮钢板固定技术(MIPPO)治疗SchatzkerⅠ~Ⅲ型胫骨平台骨折伴韧带损伤的疗效。方法回顾性分析2018年2月至2019年6月五四一总医院收治的102例SchatzkerⅠ~Ⅲ型胫骨平台骨折伴韧带损伤病人的诊疗情况。按照手术方式不同,分作观察组及对照组,各51例。对照组予以传统切开复位内固定治疗,观察组予以关节镜辅助下MIPPO术治疗。观察比较两组病人围术期指标、血液流变学(红细胞沉降率、血浆比黏度、全血比黏度浓度)、视觉模拟评分(VAS)、膝关节Lysholm评分,并比较两组的临床疗效、骨折愈合时间、骨折完全负重时间及并发症情况。结果观察组的切口长度、术中出血量、术后引流量、术后下床时间、住院时间均明显小于或少于对照组,差异有统计学意义(P<0.05);两组手术时间比较,差异无统计学意义(P>0.05);术后,两组红细胞沉降率、血浆比黏度、全血比黏度浓度指标均明显降低(P<0.05),且观察组较对照组低,差异有统计学意义(P<0.05);术后,两组的VAS评分均下降,膝关节Lysholm评分均明显升高(P<0.05);且观察组的VAS评分明显低于对照组[(2.97±0.36)分比(3.19±0.27)分],关节Lysholm评分明显高于对照组[(90.49±3.07)分比(81.42±7.64)分],差异有统计学意义(P<0.05);观察组优良率明显高于对照组,差异有统计学意义(90.20%比72.55%,P<0.05);观察组骨折愈合时间[(12.64±1.19)周比(13.96±1.36)周]、骨折完全负重时间[(14.86±1.21)周比(16.43±2.55)周]均明显短于对照组,差异有统计学意义(P<0.05);观察组并发症总发生率明显低于对照组,差异有统计学意义(3.92%比19.61%,P<0.05)。结论关节镜辅助下MIPPO术治疗SchatzkerⅠ~Ⅲ型胫骨平台骨折伴韧带损伤的疗效肯定,能明显缩短骨折愈合时间,促进膝关节功能的恢复,值得推广应用。

Objective To investigate the curative effect and prognosis of minimally invasive percutaneous plate fixation(MIPPO)assisted by arthroscope in the treatment of Schatzker Ⅰ-Ⅲ tibial plateau fracture with ligament injury.Methods The diagnosis and treatment of 102 patients with Schatzker Ⅰ-Ⅲ tibial plateau fracture and ligament injury in Wusiyi General Hospital from February 2018 to June 2019 were analyzed retrospectively.According to different surgical methods,they were divided into research group and control group,with 51 cases in each group.The control group was treated with traditional open reduction and internal fixation,while the research group was treated with MIPPO assisted by arthroscope.Perioperative indicators,hemorheology(erythrocyte sedimentation rate,plasma specific viscosity,whole blood specific viscosity concentration),visual analogue scale(VAS),Lysholm score of knee joint were observed and compared between the two groups,and the clinical efficacy,fracture healing time,complete weight-bearing time and complications of the two groups were compared.Results The incision length,intraoperative blood loss,postoperative drainage volume,postoperative time of getting out of bed and hospitalization time in the research group were significantly smaller than those in the control group,the difference was statistically significant(P<0.05);there was no significant difference in operation time between the two groups(P>0.05);after operation,the indexes of erythrocyte sedimentation rate,plasma specific viscosity and whole blood specific viscosity decreased significantly in both groups(P<0.05),and the research group was lower than the control group,the difference was statistically significant(P<0.05);after operation,VAS scores of both groups decreased,and Lysholm scores of knee joints increased significantly(P<0.05),the VAS score of the research group was significantly lower than that of the control group[(2.97±0.36)vs.(3.19±0.27)],and the Lysholm score of joints was significantly higher than that of the control group[(90.49±3.07)vs.(81.42±7.64)](P<0.05);the excellent and good rate of the research group was significantly higher than that of the control group,the difference was statistically significant(90.20%vs.72.55%,P<0.05);the fracture healing time[(12.64±1.19)week vs.(13.96±1.36)week]and full fracture loading time[(14.86±1.21)week vs.(16.43±2.55)week]in the study group were significantly shorter than those in the control group,the difference was statistically significant(P<0.05);the total incidence of complications in the research group was significantly lower than that in the control group,the difference was statistically significant(3.92%vs.19.61%,P<0.05).Conclusion Arthroscopic-assisted MIPPO surgery for Schatzker Ⅰ-Ⅲ tibial plateau fracture with ligament injury is effective,which can obviously shorten the healing time of fracture and promote the recovery of knee joint function,and is worthy of popularization and application.