关节镜辅助下复位与传统切开复位钢板内固定治疗胫骨平台骨折疗效研究
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摘要
目的探讨关节镜辅助下复位与传统切开复位钢板内固定治疗胫骨平台骨折的临床疗效。方法回顾性分析自2015年3月至2017年3月收治的70例胫骨平台新鲜骨折患者的临床资料,分为A组(n=35)与B组(n=35)。其中,A组患者采用传统切开复位钢板内固定治疗,B组患者采用关节镜辅助下经皮钢板内固定治疗。记录两组患者手术指标、术后并发症发生情况,并于术后采用美国特种外科医院膝关节评分评估患者膝关节功能,评价治疗效果。结果 B组患者手术时间、切口长度均短于A组,术中出血量少于A组,差异均有统计学意义(P<0.05)。A组患者术后出现关节僵直2例(5.7%),畸形愈合1例(2.9%),创伤性关节炎4例(11.4%);B组患者术后出现创伤性关节炎1例(2.9%)。B组患者术后并发症发生率为2.9%(1/35),明显低于A组的20.0%(7/35),差异有统计学意义(P<0.05)。B组患者治疗后优良率为80.0%(28/35),明显高于A组的57.1%(20/35),差异有统计学意义(P<0.05)。结论关节镜辅助下复位钢板内固定治疗胫骨平台骨折,手术时间、切口长度较短,术中出血量较少,且术后并发症发生率低,临床疗效较好。
Objective To investigate the clinical effect of arthroscopy assisted reduction and traditional open reduction plate internal fixation in the treatment of tibial plateau fracture.Methods A retrospective study was performed on 70 cases of patients with fresh tibial plateau fracture who were admitted from March 2015 to March 2017.Patients were divided into the Group A(n=35)and Group B(n=35).Among them,patients in Group A were treated with traditional open reduction plate internal fixation,while patients in Group B were treated with arthroscopy assisted percutaneous plate internal fixation.Surgical indicators and postoperative complications of the two groups were recorded,and the knee function of the patients was assessed by the knee joint score of the hospital for special surgery(HSS) in the United States,and the therapeutic effect was evaluated.Results The operative time and incision length of patients in Group B were shorter than those in Group A,and the intraoperative blood loss was less than that in Group A,with statistically significant differences(P<0.05).In Group A,2 patients(5.7%)developed joint rigor after surgery,1 patient(2.9%)had malunion,and 4 patients(11.4%)had traumatic arthritis.Postoperative traumatic arthritis occurred in 1 patient(2.9%)in Group B.The incidence of postoperative complications in Group B was 2.9%(1/35),which was significantly lower than 20.0%(7/35)in Group A(P<0.05).The excellent and good rate of Group B was 80.0%(28/35)after treatment,significantly higher than 57.1%(20/35)of Group A(P<0.05).Conclusion Arthroscopy assisted reduction and plate internal fixation for tibial plateau fracture resulted in shorter operative time,shorter incision length,less intraoperative blood loss,lower incidence of postoperative complications and better clinical efficacy.
Objective To investigate the clinical effect of arthroscopy assisted reduction and traditional open reduction plate internal fixation in the treatment of tibial plateau fracture.Methods A retrospective study was performed on 70 cases of patients with fresh tibial plateau fracture who were admitted from March 2015 to March 2017.Patients were divided into the Group A(n=35)and Group B(n=35).Among them,patients in Group A were treated with traditional open reduction plate internal fixation,while patients in Group B were treated with arthroscopy assisted percutaneous plate internal fixation.Surgical indicators and postoperative complications of the two groups were recorded,and the knee function of the patients was assessed by the knee joint score of the hospital for special surgery(HSS) in the United States,and the therapeutic effect was evaluated.Results The operative time and incision length of patients in Group B were shorter than those in Group A,and the intraoperative blood loss was less than that in Group A,with statistically significant differences(P<0.05).In Group A,2 patients(5.7%)developed joint rigor after surgery,1 patient(2.9%)had malunion,and 4 patients(11.4%)had traumatic arthritis.Postoperative traumatic arthritis occurred in 1 patient(2.9%)in Group B.The incidence of postoperative complications in Group B was 2.9%(1/35),which was significantly lower than 20.0%(7/35)in Group A(P<0.05).The excellent and good rate of Group B was 80.0%(28/35)after treatment,significantly higher than 57.1%(20/35)of Group A(P<0.05).Conclusion Arthroscopy assisted reduction and plate internal fixation for tibial plateau fracture resulted in shorter operative time,shorter incision length,less intraoperative blood loss,lower incidence of postoperative complications and better clinical efficacy.
引文
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[3] Chiu CH,Cheng CY,Tsai MC,et al.Arthroscopy-assisted reduction of posteromedial tibial plateau fractures with buttress plate and cannulated screw construct[J].Arthoscopy,2013,29(8):1346-1354.
[4] Fang ZM,Cheng HY,Yu DG.Double-plating internal fixation through combined approaches for the treatment of medial tibial plateau fractures with fracture-dislocation type[J].Zhongguo Gu Shang,2015,28(3):276-278.
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[7] 黄兆松,康乐,庞炜.关节镜辅助双侧锁定钢板治疗复杂胫骨平台骨折临床观察[J].临床军医杂志,2018,46(4):442-443,446.
[8] 潘月帆,黄俊文,黄安劲,等.关节镜辅助下微创治疗SchatzkerⅠ-Ⅳ型胫骨平台骨折的临床研究[J].中华骨与关节外科杂志,2016,9(1):53-56.
[9] 魏文强,张会久,李雨佳,等.关节镜下微创内固定结合术后早期综合康复锻炼治疗27例胫骨平台骨折的疗效[J].中国内镜杂志,2016,22(8):46-51.
[10] Chen XZ,Liu CG,Chen Y,et al.Arthroscopy-assisted surgery for tibial plateau fractures[J].Arthroscopy,2015,31(1):143-153.
[11] 李捷,潘磊,黄必留,等.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[J].中华骨与关节外科杂志效,2015,8(2):120-124.
[12] 吕科,雷文黎,姜猛,等.关节镜辅助术及开放式手术治疗胫骨平台骨折效果研究[J].临床军医杂志,2018,46(9):1089-1090.
[13] 杨辉,张艳金.冰敷在四肢骨折早期应用的疗效观察[J].深圳中西医结合杂志,2015,25(1):127-128.
[14] 吕小娟,邓王艳,岳琴.骨科创伤初期冰袋冷敷护理效果研究[J].临床医学,2015,28(8):196.
[15] Dodd A,Oddone Paolucci E,Korley R.The effect of three-dimensional computed tomography reconstructions on preoperative planning of tibial plateau fractures:a case-control series[J].BMC Musculoskelet Disord,2015,16:144.
[16] 余晶晶,王娟,胡晨辰.优化护理对创伤性骨折患者早期康复训练的依从性的影响及应用效果观察[J].实用临床医药杂志,2017,21(14):199-200.
[17] 刘雄业,王荣生,石裕明.锁定钢板加植骨固定联合早期功能锻炼在胫骨平台骨折患者治疗中的应用研究[J].中国当代医药,2018,25(23):102-105.
[18] 顾立强.胫骨平台骨折的分类与功能评价[J].中华创伤骨科杂志,2004,6(3):323-323.
[19] Haller JM,Holt DC,McFadden ML,et al.Arthrofibrosis of the knee following a fracture of the tibial plateau[J].Bone Joint J,2015,97-B(1):109-114.
[20] Li YS,Dong J,Yue X,et al.Treatment and analysis of the early postoperative complications of tibial plateau fractures[J].Zhongguo Gu Shang,2015,28(9):846-849.
[2] Burdin G.Arthroscopic management of tibial plateau fractures:satgical technique[J].Orthop Traumatol Surg Res,2013,99(1):208-218.
[3] Chiu CH,Cheng CY,Tsai MC,et al.Arthroscopy-assisted reduction of posteromedial tibial plateau fractures with buttress plate and cannulated screw construct[J].Arthoscopy,2013,29(8):1346-1354.
[4] Fang ZM,Cheng HY,Yu DG.Double-plating internal fixation through combined approaches for the treatment of medial tibial plateau fractures with fracture-dislocation type[J].Zhongguo Gu Shang,2015,28(3):276-278.
[5] Neogi DS,Trikha V,Mishra KK,et al.Comparative study of single lateral locked plating versus double plating in type C bicondylar tibial plateau fractures[J].Indian J Orthop,2015,49(2):193-198.
[6] Hartigan DE,McCarthy MA,Krych AJ,et al.Arthroscopic-assisted reduction and percutaneous fixation of tibial plateau fractures[J].Arthrosc Tech,2015,4(1):e51-e55.
[7] 黄兆松,康乐,庞炜.关节镜辅助双侧锁定钢板治疗复杂胫骨平台骨折临床观察[J].临床军医杂志,2018,46(4):442-443,446.
[8] 潘月帆,黄俊文,黄安劲,等.关节镜辅助下微创治疗SchatzkerⅠ-Ⅳ型胫骨平台骨折的临床研究[J].中华骨与关节外科杂志,2016,9(1):53-56.
[9] 魏文强,张会久,李雨佳,等.关节镜下微创内固定结合术后早期综合康复锻炼治疗27例胫骨平台骨折的疗效[J].中国内镜杂志,2016,22(8):46-51.
[10] Chen XZ,Liu CG,Chen Y,et al.Arthroscopy-assisted surgery for tibial plateau fractures[J].Arthroscopy,2015,31(1):143-153.
[11] 李捷,潘磊,黄必留,等.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[J].中华骨与关节外科杂志效,2015,8(2):120-124.
[12] 吕科,雷文黎,姜猛,等.关节镜辅助术及开放式手术治疗胫骨平台骨折效果研究[J].临床军医杂志,2018,46(9):1089-1090.
[13] 杨辉,张艳金.冰敷在四肢骨折早期应用的疗效观察[J].深圳中西医结合杂志,2015,25(1):127-128.
[14] 吕小娟,邓王艳,岳琴.骨科创伤初期冰袋冷敷护理效果研究[J].临床医学,2015,28(8):196.
[15] Dodd A,Oddone Paolucci E,Korley R.The effect of three-dimensional computed tomography reconstructions on preoperative planning of tibial plateau fractures:a case-control series[J].BMC Musculoskelet Disord,2015,16:144.
[16] 余晶晶,王娟,胡晨辰.优化护理对创伤性骨折患者早期康复训练的依从性的影响及应用效果观察[J].实用临床医药杂志,2017,21(14):199-200.
[17] 刘雄业,王荣生,石裕明.锁定钢板加植骨固定联合早期功能锻炼在胫骨平台骨折患者治疗中的应用研究[J].中国当代医药,2018,25(23):102-105.
[18] 顾立强.胫骨平台骨折的分类与功能评价[J].中华创伤骨科杂志,2004,6(3):323-323.
[19] Haller JM,Holt DC,McFadden ML,et al.Arthrofibrosis of the knee following a fracture of the tibial plateau[J].Bone Joint J,2015,97-B(1):109-114.
[20] Li YS,Dong J,Yue X,et al.Treatment and analysis of the early postoperative complications of tibial plateau fractures[J].Zhongguo Gu Shang,2015,28(9):846-849.