关节镜辅助经皮内固定和切开复位内固定治疗Schatzker Ⅱ、Ⅲ型胫骨平台骨折的疗效
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摘要
目的对比分析关节镜辅助经皮内固定和切开复位内固定治疗Schatzker Ⅱ、Ⅲ型胫骨平台骨折的疗效差异。方法回顾性分析2013年1月至2016年1月期间共收治Schatzker Ⅱ、Ⅲ型胫骨平台骨折患者68例资料,根据手术方法将其分成两组,其中40例选用关节镜辅助经皮内固定治疗者为观察组,28例选用切开复位内固定治疗者为对照组。分析对比两组患者各手术指标、临床治疗效果、术后并发症情况。结果观察组患者手术时间(53. 75±5. 64) min、术中出血量(59. 45±5. 38) ml、切口大小(6. 17±0. 65) cm、术后离床时间(3. 35±0. 46) d、术后完全负重时间(3. 62±0. 38)月、骨折愈合时间(3. 44±0. 40)月,与对照组[(89. 57±8. 56) min、(108. 22±9. 54) ml、(17. 72±1. 87) cm、(5. 36±0. 47) d、(4. 87±0. 42)月、(4. 65±0. 52)月]比较均明显减少(P <0. 05),关节活动度(123. 35±6. 86)°、HSS评分(107. 20±6. 43)分与对照组[(111. 86±5. 65)°、(82. 34±5. 23)分]比较均明显增加(P <0. 05)。观察组治疗优良率为90. 00%,与对照组(71. 43%)比较明显提高(P <0. 05)。观察组术后并发症发生率为12. 50%,与对照组(32. 14%)比较明显降低(P <0. 05)。结论关节镜辅助经皮内固定治疗SchatzkerⅡ、Ⅲ型胫骨平台骨折创伤小、复位好、恢复快、并发症少,安全、可靠,可作为临床治疗首选,但对手术要求高,且要充分考虑手术禁忌证选择应用。
Objective To compare the efficacy of arthroscopic-assisted percutaneous fixation and open reduction internal fixation in the treatment of tibial plateau fractures of Schatzker Ⅱ and Ⅲ. Methods 68 patients of Schatzker Ⅱ/Ⅲ tibial plateau fractures from January 2013 and January 2016 were retrospectively randomized into two groups,namely observation group with arthroscopy( n = 40) and control group with ORIF( n = 28). The clinical outcomes of the two groups of patients were analyzed and compared. Results For the observation group,the operation time( 53. 75 ± 5. 64) min,blood loss( 59. 45 ± 5. 38) ml,incision size( 6. 17 ± 0. 65) cm,postoperative bed rest( 3. 35 ± 0. 46) d,postoperative full weight-bearing( 3. 62 ± 0. 38) mo,and the healing time( 3. 44 ± 0. 40) mo were significantly reduced compared with control [( 89. 57± 8. 56) min,( 108. 22 ± 9. 54) ml,( 17. 72 ± 1. 87) cm,( 5. 36 ± 0. 47) d,( 4. 87 ± 0. 42) mo,( 4. 65 ± 0. 52) mo,P < 0. 05]. The joint range of motion( 123. 35 ± 6. 86) °,HSS score( 107. 20 ± 6. 43) were significantly increased than control [( 111. 86 ± 5. 65) °,( 82. 34 ± 5. 23)scores,P < 0. 05]. 90% of the observation group was scored excellent to satisfactory,which was higher than control( 71. 43%,P < 0. 05). The incidence of postoperative complications in the observation group was 12. 50%,which was significantly lower than control( 32. 14%,P < 0. 05).Conclusion Arthroscopic-assisted percutaneous fixation has an edge over ORIF in the treatment of Schatzker type tibial plateau fracture for its less incision,quick recovery,fewer complications,higher safety and reliability.
Objective To compare the efficacy of arthroscopic-assisted percutaneous fixation and open reduction internal fixation in the treatment of tibial plateau fractures of Schatzker Ⅱ and Ⅲ. Methods 68 patients of Schatzker Ⅱ/Ⅲ tibial plateau fractures from January 2013 and January 2016 were retrospectively randomized into two groups,namely observation group with arthroscopy( n = 40) and control group with ORIF( n = 28). The clinical outcomes of the two groups of patients were analyzed and compared. Results For the observation group,the operation time( 53. 75 ± 5. 64) min,blood loss( 59. 45 ± 5. 38) ml,incision size( 6. 17 ± 0. 65) cm,postoperative bed rest( 3. 35 ± 0. 46) d,postoperative full weight-bearing( 3. 62 ± 0. 38) mo,and the healing time( 3. 44 ± 0. 40) mo were significantly reduced compared with control [( 89. 57± 8. 56) min,( 108. 22 ± 9. 54) ml,( 17. 72 ± 1. 87) cm,( 5. 36 ± 0. 47) d,( 4. 87 ± 0. 42) mo,( 4. 65 ± 0. 52) mo,P < 0. 05]. The joint range of motion( 123. 35 ± 6. 86) °,HSS score( 107. 20 ± 6. 43) were significantly increased than control [( 111. 86 ± 5. 65) °,( 82. 34 ± 5. 23)scores,P < 0. 05]. 90% of the observation group was scored excellent to satisfactory,which was higher than control( 71. 43%,P < 0. 05). The incidence of postoperative complications in the observation group was 12. 50%,which was significantly lower than control( 32. 14%,P < 0. 05).Conclusion Arthroscopic-assisted percutaneous fixation has an edge over ORIF in the treatment of Schatzker type tibial plateau fracture for its less incision,quick recovery,fewer complications,higher safety and reliability.
引文
[1]袁伟,石洋,樊洁.切开复位植骨内固定结合关节镜下治疗SchatzkerⅢ型胫骨平台骨折短期疗效观察[J].现代诊断与治疗,2012,23(10):1741-1742.
[2]徐俊余.SchatzkerⅡ、Ⅲ型胫骨平台骨折行切开复位内固定治疗临床观察探讨[J].中外医学研究,2013,11(21):194-195.
[3]邱惠斌,郭宁峰,庞清江.关节镜辅助复位空心钉内固定与切复钢板内固定治疗SchatzkerIII型胫骨平台骨折疗效分析[J].现代实用医学,2015,27(6):719-721.
[4]沈光银,周建中.关节镜辅助经皮内固定和切开复位内固定治疗SchatzkerⅡ、Ⅲ型胫骨平台骨折的比较研究[J].中国修复重建外科杂志,2011,25(10):1201-1204.
[5]顾梦臻,唐献忠,李永山.关节镜辅助经皮内固定与切开复位内固定治疗胫骨平台骨折的近期疗效比较[J].中国骨与关节损伤杂志,2015,30(12):1325-1326.
[6]肖笠,徐静,蔡金宏,等.三种手术方式治疗SandersⅢ~Ⅳ型跟骨骨折的疗效对比研究[J].临床和实验医学杂志,2016,15(2):143-146.
[7]冯立科,杨文斌.关节镜辅助下撬拨复位经皮螺钉内固定治疗SchatzkerⅢ型胫骨平台骨折[J].中国骨与关节损伤杂志,2013,28(5):127.
[8]卢国平,陈永华,洪晓亮.关节镜辅助下手术内固定与切开复位内固定治疗胫骨平台骨折的疗效对比[J].检验医学与临床,2014,11(10):1365-1366.
[9]舒帆,许楠健,杨凯,等.关节镜辅助下手术治疗Schatzker II~III型胫骨平台骨折疗效观察[J].现代实用医学,2015,27(12):1637-1638.
[10]曾尚广.关节镜辅助下微创复位内固定治疗SchatzkerⅢ型胫骨平台骨折的疗效[J].实用骨科杂志,2015,21(12):1085-1087.
[11]赵森,卫小春.关节镜下微创治疗与切开复位内固定治疗胫骨平台骨折疗效的分析[J].中国骨与关节杂志,2014,3(5):385-389.
[2]徐俊余.SchatzkerⅡ、Ⅲ型胫骨平台骨折行切开复位内固定治疗临床观察探讨[J].中外医学研究,2013,11(21):194-195.
[3]邱惠斌,郭宁峰,庞清江.关节镜辅助复位空心钉内固定与切复钢板内固定治疗SchatzkerIII型胫骨平台骨折疗效分析[J].现代实用医学,2015,27(6):719-721.
[4]沈光银,周建中.关节镜辅助经皮内固定和切开复位内固定治疗SchatzkerⅡ、Ⅲ型胫骨平台骨折的比较研究[J].中国修复重建外科杂志,2011,25(10):1201-1204.
[5]顾梦臻,唐献忠,李永山.关节镜辅助经皮内固定与切开复位内固定治疗胫骨平台骨折的近期疗效比较[J].中国骨与关节损伤杂志,2015,30(12):1325-1326.
[6]肖笠,徐静,蔡金宏,等.三种手术方式治疗SandersⅢ~Ⅳ型跟骨骨折的疗效对比研究[J].临床和实验医学杂志,2016,15(2):143-146.
[7]冯立科,杨文斌.关节镜辅助下撬拨复位经皮螺钉内固定治疗SchatzkerⅢ型胫骨平台骨折[J].中国骨与关节损伤杂志,2013,28(5):127.
[8]卢国平,陈永华,洪晓亮.关节镜辅助下手术内固定与切开复位内固定治疗胫骨平台骨折的疗效对比[J].检验医学与临床,2014,11(10):1365-1366.
[9]舒帆,许楠健,杨凯,等.关节镜辅助下手术治疗Schatzker II~III型胫骨平台骨折疗效观察[J].现代实用医学,2015,27(12):1637-1638.
[10]曾尚广.关节镜辅助下微创复位内固定治疗SchatzkerⅢ型胫骨平台骨折的疗效[J].实用骨科杂志,2015,21(12):1085-1087.
[11]赵森,卫小春.关节镜下微创治疗与切开复位内固定治疗胫骨平台骨折疗效的分析[J].中国骨与关节杂志,2014,3(5):385-389.