关节镜辅助下复位固定治疗Schatzker Ⅰ～Ⅴ型胫骨平台骨折的疗效及影响因素分析
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摘要
目的 评价关节镜辅助复位内固定治疗Schatzker Ⅰ～Ⅴ型胫骨平台骨折的临床疗效及其预后的影响因素。方法 回顾性分析中南大学湘雅医学院附属海口医院2015年7月—2017年7月应用关节镜辅助复位内固定治疗的16例SchatzkerⅠ～Ⅴ型胫骨平台骨折患者临床资料,男性9例,女性7例;右膝10例,左膝6例;平均年龄43.44岁(21～65岁),其中60岁以下非老年组13例,60岁(含60岁)以上老年组3例;术后1、3、6个月及1年门诊摄患膝正侧位X线片复查进行骨折愈合情况影像学评估并采用HSS膝关节功能评分记录患膝功能;采用Fisher率比较法和多因素Logistic回归分析各单因素对手术预后的影响及其预后的独立因素。结果 16例患者术后获平均(14.31±2.36)个月门诊随访,术后平均(3.94±1.12)个月骨折均达到骨性愈合,发生创伤性关节炎2例。末次随访时HSS膝关节功能评分优、良共14例,可2例,优良率87.5%。单因素Fisher分析结果显示年龄单因素中非老年组优良率高于老年组,差异具有统计学意义(P=0.025<0.05);而不同骨折类型(P=1.000>0.05)、关节内合并伤(P=0.083>0.05)等各因素组内比较差异无统计学意义;多因素Logistic回归分析结果显示年龄是影响关节镜下辅助复位固定胫骨平台预后的主要因素(P=0.03<0.05)。结论 关节镜辅助下复位内固定术是治疗SchatzkerⅠ～Ⅴ型胫骨平台骨折的可行有效的微创方法,而年龄是影响预后的危险独立因素。
Objective To investigate the clinical outcomes and risk factors of arthroscopy-assisted reduction and internal fixation(ARIF) of tibial plateau fractures. Methods Sixteen patients with tibial plateau fractures(Schatzker type stage Ⅰ-Ⅴ) who were treated with ARIF from Jul.2015 to Jul.2017 were included in this retrospective study. There were 9 males and 7 females,10 right knees and 6 left knees;their age ranged from 21 to 65 years,with an average age of 43.44 years. Thirteen patients were under 60 years old,and three patients were over 60 years. At 1 week,3 months,6 months,and 1 year after surgery,X-ray films of the knee were performed for evaluating fracture healing,HSS scores were used to record knee function,Fisher's Exact Test and multivariate logistic regression analysis were performed to analyze the influence of each single factor on the prognosis of surgery and the independent factors of prognosis. Results Sixteen patients were followed up for an average of(14.31±2.36) months, and their average postoperative bone healing was(3.94±1.12) months. Two cases of traumatic arthritis occurred. At the last follow-up,HSS knee joint function score was excellent and good in 14 cases,fair in 2 cases,and the excellent and good rate was 87.5%. Univariate Fisher analysis showed that the rate of excellent and good rate of non-elderly group was higher than that of the elderly group,and the difference was statistically significant(P=0.025<0.05). There was no difference in fracture types(P=1.000>0.05) and intra-articular injury(P=0.083>0.05) between groups. The multivariate logistic regression analysis showed that age was the main factor affecting the prognosis of arthroscopic auxiliary reduction and fixation of the tibial plateau(P=0.03<0.05). Conclusion ARIF treatment can achieve functionally successful outcomes for patients with tibial plateau fractures,but age appears as a risk factor for adverse outcomes.
Objective To investigate the clinical outcomes and risk factors of arthroscopy-assisted reduction and internal fixation(ARIF) of tibial plateau fractures. Methods Sixteen patients with tibial plateau fractures(Schatzker type stage Ⅰ-Ⅴ) who were treated with ARIF from Jul.2015 to Jul.2017 were included in this retrospective study. There were 9 males and 7 females,10 right knees and 6 left knees;their age ranged from 21 to 65 years,with an average age of 43.44 years. Thirteen patients were under 60 years old,and three patients were over 60 years. At 1 week,3 months,6 months,and 1 year after surgery,X-ray films of the knee were performed for evaluating fracture healing,HSS scores were used to record knee function,Fisher's Exact Test and multivariate logistic regression analysis were performed to analyze the influence of each single factor on the prognosis of surgery and the independent factors of prognosis. Results Sixteen patients were followed up for an average of(14.31±2.36) months, and their average postoperative bone healing was(3.94±1.12) months. Two cases of traumatic arthritis occurred. At the last follow-up,HSS knee joint function score was excellent and good in 14 cases,fair in 2 cases,and the excellent and good rate was 87.5%. Univariate Fisher analysis showed that the rate of excellent and good rate of non-elderly group was higher than that of the elderly group,and the difference was statistically significant(P=0.025<0.05). There was no difference in fracture types(P=1.000>0.05) and intra-articular injury(P=0.083>0.05) between groups. The multivariate logistic regression analysis showed that age was the main factor affecting the prognosis of arthroscopic auxiliary reduction and fixation of the tibial plateau(P=0.03<0.05). Conclusion ARIF treatment can achieve functionally successful outcomes for patients with tibial plateau fractures,but age appears as a risk factor for adverse outcomes.
引文
[1] Borrelli J Jr.Management of soft tissue injuries associated with tibial plateau fractures[J].J Knee Surg,2014,27(1):5-9.
[2] Kugelman D,Qatu A,Haglin J,et al.Complications and unplanned outcomes following operative treatment of tibial plateau fractures[J].Injury,2017,48(10):2221-2229.
[3] 袁功武,聂宇,刘曦明,等.3D 打印技术辅助治疗与传统手术方法治疗复杂胫骨平台骨折的对比研究 [J].创伤外科杂志,2018,20(5):324-328.
[4] Caspari RB,Hutton PM,Whipple TL,et al.The role of arthroscopy in the management of tibial plateau fractures[J].Arthroscopy,1985,1(2):76-82.
[5] Burdin G.Arthroscopic management of tibial plateau fractures:Surgical technique[J].Orthop Traumatol Surg Res,2013,99(S):208-218.
[6] 李捷,潘磊,黄必留.关节镜下微创内固定系统治疗外侧胫骨平台骨折合并软组织损伤的疗效[J].中华骨与关节外科杂志,2015,8(2):120-124.
[7] Chen XZ,Liu CG,Chen Y,et al.Arthroscopy-assisted surgery for tibial plateau fractures[J].Arthroscopy,2015,31(1):143-153.
[8] Chen HW,Liu GD,Wu LJ.Clinical and radiological outcomes following arthroscopic-assisted management of tibial plateau fractures:a systematic review[J].Knee Surg Sports Trauma Arthrosc,2015,23(12):3464-3472.
[9] 顾三军,李海峰,芮永军,等.关节镜下微创治疗胫骨平台后柱骨折[J].中华创伤骨科杂志,2016,18(4):351-353.
[10] Krause M,Preiss A,Meenen NM,et al."Fracturoscopy" is superior to fluoroscopy in the articular reconstruction of complex tibial plateau fractures-an arthroscopy assisted fracture reduction technique[J].J Orthop Trauma,2016,30(8):437-444.
[11] Manidakis N,Dosani A,Dimitriou R,et al.Tibial plateau fractures:functional outcome and incidence of osteoarthritis in 125 cases[J].Int Orthop,2010,34(4):565-570.
[12] Park HJ,Lee HD,Cho JH.The Efficacy of Meniscal Treatment Associated withLateral Tibial Plateau Fractures[J].Knee Surg Relat Res,2017,29(2):137-143.
[13] Forman JM,Karia RJ,Davidovitch RI,et al.Tibial plateau fractures with and without meniscus tear--results of a standardized treatment protocol[J].Bull Hosp Jt Dis,2013,71(2):144-151.
[14] Warner SJ,Garner MR,Schottel PC,et al.The effect of soft tissue injuries on clinical outcomes after tibial plateau fracture fixation[J].J Orthop Trauma,2018,32(3):141-147.
[15] Wasserstein D,Henry P,Paterson JM,et al.Risk of total knee arthroplasty after operatively treated tibial plateau fracture:a matched-population-based cohort study [J].J Bone Joint Surg(Am),2014,96(2):144-150.
[2] Kugelman D,Qatu A,Haglin J,et al.Complications and unplanned outcomes following operative treatment of tibial plateau fractures[J].Injury,2017,48(10):2221-2229.
[3] 袁功武,聂宇,刘曦明,等.3D 打印技术辅助治疗与传统手术方法治疗复杂胫骨平台骨折的对比研究 [J].创伤外科杂志,2018,20(5):324-328.
[4] Caspari RB,Hutton PM,Whipple TL,et al.The role of arthroscopy in the management of tibial plateau fractures[J].Arthroscopy,1985,1(2):76-82.
[5] Burdin G.Arthroscopic management of tibial plateau fractures:Surgical technique[J].Orthop Traumatol Surg Res,2013,99(S):208-218.
[6] 李捷,潘磊,黄必留.关节镜下微创内固定系统治疗外侧胫骨平台骨折合并软组织损伤的疗效[J].中华骨与关节外科杂志,2015,8(2):120-124.
[7] Chen XZ,Liu CG,Chen Y,et al.Arthroscopy-assisted surgery for tibial plateau fractures[J].Arthroscopy,2015,31(1):143-153.
[8] Chen HW,Liu GD,Wu LJ.Clinical and radiological outcomes following arthroscopic-assisted management of tibial plateau fractures:a systematic review[J].Knee Surg Sports Trauma Arthrosc,2015,23(12):3464-3472.
[9] 顾三军,李海峰,芮永军,等.关节镜下微创治疗胫骨平台后柱骨折[J].中华创伤骨科杂志,2016,18(4):351-353.
[10] Krause M,Preiss A,Meenen NM,et al."Fracturoscopy" is superior to fluoroscopy in the articular reconstruction of complex tibial plateau fractures-an arthroscopy assisted fracture reduction technique[J].J Orthop Trauma,2016,30(8):437-444.
[11] Manidakis N,Dosani A,Dimitriou R,et al.Tibial plateau fractures:functional outcome and incidence of osteoarthritis in 125 cases[J].Int Orthop,2010,34(4):565-570.
[12] Park HJ,Lee HD,Cho JH.The Efficacy of Meniscal Treatment Associated withLateral Tibial Plateau Fractures[J].Knee Surg Relat Res,2017,29(2):137-143.
[13] Forman JM,Karia RJ,Davidovitch RI,et al.Tibial plateau fractures with and without meniscus tear--results of a standardized treatment protocol[J].Bull Hosp Jt Dis,2013,71(2):144-151.
[14] Warner SJ,Garner MR,Schottel PC,et al.The effect of soft tissue injuries on clinical outcomes after tibial plateau fracture fixation[J].J Orthop Trauma,2018,32(3):141-147.
[15] Wasserstein D,Henry P,Paterson JM,et al.Risk of total knee arthroplasty after operatively treated tibial plateau fracture:a matched-population-based cohort study [J].J Bone Joint Surg(Am),2014,96(2):144-150.