关节镜辅助下微创经皮钢板内固定治疗开放性胫骨平台骨折患者的临床价值研究

Clinical Value of Minimally Invasive Percutaneous Plate Internal Fixation Assisted by Arthroscopy in the Treatment of Patients with Open Tibial Plateau Fractures

目的:对比传统切开复位内固定术及关节镜辅助下微创经皮钢板内固定术,探讨关节镜辅助下微创经皮钢板内固定治疗开放性胫骨平台骨折患者的临床价值。方法:选取2017年5月—2019年1月许昌市立医院收治的92例胫骨平台骨折患者作为研究对象,根据治疗方法不同分为观察组(44例,予以关节镜辅助下微创经皮钢板内固定术治疗)和对照组(48例,予以传统切开复位内固定术治疗)。对比两组患者围手术期指标、膝关节功能恢复情况、手术前后应激指标水平变化情况,随访膝关节活动度、术后并发症发生率及影像学指标改善情况。结果:观察组患者切口长度、手术时间、住院时间、愈合时间均明显短于对照组,术后引流量明显少于对照组,差异有统计学意义(t=22.819、20.689、4.100、8.175、23.375,P<0.05);对照组优良率明显低于观察组,差异有统计学意义(χ^(2)=4.611,P<0.05);术后1 d及术后3 d,观察组SOD、Cor、TAC水平低于对照组,差异有统计学意义(P<0.05);观察组伸膝最大角度及屈膝最大角度均显著大于对照组,差异有统计学意义(t=2.0934、9.781,P<0.05);观察组术后并发症总发生率明显低于对照组,差异有统计学意义(χ^(2)=6.385,P<0.05);术后12个月与术后3 d比较,观察组膝关节间隙宽度明显大于对照组,差异有统计学意义(t=18.238,P<0.05)。结论:关节镜辅助下微创经皮钢板内固定术治疗开放性胫骨平台骨折术安全性高,患者术后膝关节功能恢复快,有利于促进患者康复。

Objective:To compare traditional incisional internal fixation with arthroscopic-assisted minimally invasive percuta⁃neous plate internal fixation and to discuss the clinical value of arthroscopic-assisted minimally invasive percutaneous plate inter⁃nal fixation in the treatment of patients with open tibial plateau fractures.Methods:92 patients with tibial plateau fractures admit⁃ted to the hospital from May 2017 to January 2019 were selected as the study subjects and divided into observation group(44 pa⁃tients treated with arthroscopic-assisted minimally invasive percutaneous plate internal fixation)and control group(48 patients treated with traditional incisional internal fixation)according to the treatment method.The perioperative indexes,recovery of knee function,changes in the levels of stress indexes before and after surgery,follow-up of knee mobility,incidence of postoperative complica⁃tions and improvement of imaging indexes were compared between the two groups.Results:The incision length,operation time,hospital stay,and healing time of the observation group were significantly shorter than those of the control group,and the postopera⁃tive drainage was significantly less than that of the control group,with statistically significant differences(t=22.819,20.689,4.100,8.175,23.375,P<0.05).The excellent rate in the control group was 77.08%,which was significantly lower than 93.18%in the ob⁃servation group,and the difference was statistically significant(χ^(2)=4.611,P<0.05).At 1 d and 3 d after surgery,the relevant in⁃dexes in the observation group were lower than those in the control group,and the differences in SOD,Cor and TAC levels between the two groups were statistically significant(P<0.05).The maximum angle of knee extension and maximum angle of knee flexion were significantly greater in the observation group than in the control group,with statistically significant differences(t=2.934,9.781,P<0.05).The total incidence of postoperative complications in the observation group was significantly lower than that in the control group,and the difference was statistically significant(χ^(2)=6.385,P<0.05).At 12 months postoperatively compared with 3 d postoperatively,the knee joint gap width was significantly greater in the observation group than in the control group,and the difference was statistically significant(t=18.238,P<0.05).Conclusion:Arthroscopic-assisted minimally invasive percutaneous plate internal fixation for open tibial plateau fractures is safe,and patients recover quickly from postoperative knee function,which helps promote their recovery.