胫骨平台骨折38例关节镜及C形臂X线 机微创治疗的临床研究

Clinical analysis of minimally invasive surgery under arthroscope and c-Arm x-ray monitoring for tibial plateau fractures

摘要:

目的 探讨在关节镜及C形臂X线机辅助下对胫骨平台骨折患者开展微创内固定术治疗的临床疗效和安全性分析。方法 选取该院2009年2月-2014年2月收治的38例胫骨平台骨折患者，Schatzker 分型（I型6例，II型9例，III型17例，IV型4例，V型2例）。所有患者均为新鲜闭合性骨折，术前均进行CT片、X片或MR检查，术中通过关节镜引导以及C形臂X线机辅助下对患者实施小切口复位内固定术治疗，诸如先对患者关节内合并损失进行处理，再对患者骨折实施解剖复位，并于复位后采用解剖支撑钢板或者松质骨拉力螺钉进行内固定，最后采用同种异体骨或者自体髂骨对患者缺损处进行植骨治疗，术后指导患者进行良好的早期功能恢复锻炼。结果 38例胫骨平台骨折患者均获得随访，平均（16.54±6.87）个月。38例患者术后3～5个月经X线片观察，均获得骨性愈合，均不存在关节内感染及切口感染，也无创口延迟愈合、皮肤坏死、内固定物断裂或松动等发生。Lysholm膝关节评分分析，优30例，占78.95%，良5例，占13.06%，可2例，占5.26%，差2例，占5.26%，总优良率达到92.11%。结论 在具备熟练的关节镜操作技术基础上，关节镜及C形臂X线机辅助下对胫骨平台骨折患者开展微创内固定术治疗胫骨平台骨折患者的疗效显著，安全性高，不良反应小，能够在有效复位的同时合理处理关节腔内其他合并损伤，具有重要的临床应用价值。此外，良好的手术经验及护理配合对手术的顺利进行及患者的康复均起到了较好的促进作用。

Abstract:

【Objective】 To investigate the treatment outcome of minimally invasive surgery for tibial plateau fractures under arthroscope and c-arm X-ray monitoring. 【Methods】 The clinical data of 38 patients with tibial plateau fractures (Schatzker criteria: 6 cases were classified as type I, type II as 9 cases, type III as 17 cases, type IV as 4 cases, type Vas 2 cases), treated in our hospital from February 2009 to February 2014 were retrospectively analyzed. All cases were given CT reconstruction, MR examination or X-ray examination before operation, and the fractures were reduced and fixed under arthroscope and c-arm fluoroscope during operation. With articular complications firstly treated, the dissociative fragments secondly were managed by anatomic reduction and were fixated anatomic strut plat or cancellous screws. After the bone were defected, the autografts of ilium or bone allografts were applied. 【Results】 38 patients with tibial plateau fractures were followed up for (16.54±6.87) months on average, with X-ray findings showed bone union in all 38 cases in 3~5 postoperative months. During the followed-up, there were no incision or joint infection, skin necrosis, delayed union or screw rupture. According to Lysholm knee rating system, 30 cases were excellent, 5 were good, 2 were fair and 2 were poor, with the excellent and good rate was 92.11%. 【Conclusion】 The minimally invasive surgery underarthro-seope and C-arm has advantages of less trauma, satisfactory reduction fixation and fast recovery of joint function for tibial plateau fractures; It can deal with associated injuries of knee joint at the same time. Moreover, good surgical experience and nursing has played a good role in promoting cooperate of the surgery smoothly going on and rehabilitation of patients. It is worth of further clinical apphcation.