关节镜辅助下治疗复杂胫骨平台骨折的疗效分析

Effect analysis of complex tibial plateau fracture treated by arthroscope

摘要:

目的 探讨关节镜辅助下治疗复杂胫骨平台骨折的临床疗效。方法 选取2017年1月－2018年12月51例于该院治疗的胫骨平台Schatzker Ⅴ型、Ⅵ型骨折患者，回顾性分析患者的临床治疗过程和术后随访资料。根据手术方式分为关节镜组和常规组，关节镜组24例，采用关节镜辅助下微创内固定治疗；常规组27例，采用常规切开复位内固定治疗。记录患者一般情况、切口长度、手术时间、术中出血量、术后引流量、住院时间、骨折愈合时间、完全负重时间、术后近期、远期并发症、末次随访时膝关节Rasmussen影像学评分以及膝关节损伤和骨关节炎评分（KOOS），评估手术临床疗效。结果 随访9～15个月，两组患者一般情况比较，差异无统计学意义（P > 0.05）。关节镜组手术切口长度短于常规组，差异有统计学意义（P < 0.05）。关节镜组术中出血量、住院时间、骨折愈合时间、完全负重时间明显少于常规组，差异均有统计学意义（P < 0.05）。关节镜组膝关节KOOS评分中疼痛和症状评分、Rasmussen评分中成角畸形、髁部变宽、关节面塌陷评分和优良率明显高于常规组，差异均有统计学意义（P < 0.05）。关节镜组近期和远期并发症发生率均明显低于常规组（P < 0.05）。结论 关节镜辅助下治疗复杂胫骨平台骨折与常规切开内固定治疗比较，切口小、手术时间短、住院时间、骨折愈合时间及完全负重时间短，术中出血量少，术后症状改善明显、膝关节功能恢复良好，可作为复杂胫骨平台骨折的常规治疗方法。

Abstract:

Objective To investigate the clinical effect of arthroscopic assisted treatment of complex tibial plateau fractures.Methods Retrospective analysis of 51 cases of tibia platform Schatzker Ⅴ, Ⅵ fractures from January 2017 to December 2018 were made. The patients clinical treatment and follow-up data according to the operation methods were analyzed. The patients were divided into arthroscopic group and conventional group. In arthroscopic group, 24 cases were treated with arthroscopic assisted minimally invasive internal fixation. In the conventional group, 27 cases were treated with conventional open reduction and internal fixation. Patients' general conditions, incision length, operation time, intraoperative blood loss, postoperative drainage volume, length of hospital stay, fracture healing time, total loading time, short-term and long-term postoperative complications, Rasmussen radiological score of knee joint and KOOS score at the last follow-up were recorded to compare the clinical efficacy.Results Patients in the two groups were followed up for 9～15 months, and there was no statistically significant difference in general conditions between the two groups (P > 0.05). The incision length of the arthroscopic group was shorter than that of the conventional group, and the difference was statistically significant (P < 0.05). The intraoperative blood loss, hospitalization time, fracture healing time and total load time of patients in the arthroscopic group were significantly lower than those in the conventional group, with statistically significant differences (P < 0.05). KOOS scores for pain and symptom items, Rasmussen scores for angular deformity, condyle widening, articular surface collapse, and good rates were significantly higher in the arthroscopic group than that in the conventional group, with statistically significant differences (P < 0.05). The incidence of short-term and long-term complications in the arthroscopic group was significantly lower than that in the conventional group (P < 0.05).Conclusion Arthroscopy assisted treatment for complex fractures of tibial plateau relatively routine incision fixation treatment, small incision, shorter operation time, hospitalization time, fracture healing time, full load time is short, less intraoperative bleeding, postoperative symptoms improved significantly, the recovery of knee joint function is good, can be used as the conventional treatment of complex tibial plateau fractures.