关节镜下复位内固定与切开复位内固定治疗Schatzker Ⅰ~Ⅲ型胫骨平台骨折
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摘要
目的比较关节镜下复位内固定与切开复位内固定治疗SchatzkerⅠ~Ⅲ型胫骨平台骨折的临床效果。方法将中山市港口医院2015年1月至2016年12月采用关节镜下复位内固定治疗的18例胫骨平台骨折患者纳入观察组,2013年1月至2014年12月行切开复位内固定的25例胫骨平台骨折患者纳入对照组,比较两组患者围手术期疗效指标和并发症、术后2 d Rasmussen胫骨平台骨折影像学评分及术后1年Rasmussen膝关节功能评分的差异。结果观察组手术时间、切口长度、术后引流量、下床活动时间均明显少于对照组(P<0.05);两组围手术期并发症发生率无明显差异(P>0.05);术后Rasmussen胫骨平台骨折影像学评分和膝关节功能评分均高于对照组,但差异无统计学意义(P>0.05);术后1年膝关节最大活动度明显高于对照组(P<0.05)。结论与切开复位内固定相比,关节镜下复位内固定治疗SchatzkerⅠ~Ⅲ型胫骨平台骨折能更好地发现和处理软组织损伤,手术创伤更小,膝关节活动度恢复更好。
Objective To compare the clinical effects of two surgical procedures of arthroscopic reduction and internal fixation(ARIF) versus open reduction and internal fixation(ORIF) for the treatment of Schatzker Ⅰto Ⅲ tibial plateau fractures. Methods Eighteen patients with tibial plateau fracture treated by ARIF from January 2015 to December 2016 in Zhongshan Gangkou Hospital were included in the observation group, and 25 patients who underwent ORIF from January 2013 to December 2014 were enrolled in the control group.Differences of perioperative therapeutic efficacy indexes and complications, Rasmussen imaging score of tibial plateau fracture 2 d postoperatively, as well as Rasmussen function evaluation score of knee joint 1 year after the surgery were compared between two groups. Results The operation time, length of the incision, postoperative drainage volume, and ambulation time in observation group were all lower than those in control group(P <0.05).The difference in rate of complications between two groups had no statistical significance(P >0.05).Postoperative Rasmussen imaging score and knee function evaluation score were higher in observation group,while the differences had no statistical significance between two groups(P >0.05). At 1 year after the surgery, the maximum range of motion(ROM) of the knee joint in observation group was higher than that in control group(P <0.05). Conclusion For the treatment of tibial plateau fracture, ARIF could help surgeons find and treat soft tissue injuries more accurately, and has the advantages of less trauma and better recovery of knee joint ROM when compared to ORIF.
Objective To compare the clinical effects of two surgical procedures of arthroscopic reduction and internal fixation(ARIF) versus open reduction and internal fixation(ORIF) for the treatment of Schatzker Ⅰto Ⅲ tibial plateau fractures. Methods Eighteen patients with tibial plateau fracture treated by ARIF from January 2015 to December 2016 in Zhongshan Gangkou Hospital were included in the observation group, and 25 patients who underwent ORIF from January 2013 to December 2014 were enrolled in the control group.Differences of perioperative therapeutic efficacy indexes and complications, Rasmussen imaging score of tibial plateau fracture 2 d postoperatively, as well as Rasmussen function evaluation score of knee joint 1 year after the surgery were compared between two groups. Results The operation time, length of the incision, postoperative drainage volume, and ambulation time in observation group were all lower than those in control group(P <0.05).The difference in rate of complications between two groups had no statistical significance(P >0.05).Postoperative Rasmussen imaging score and knee function evaluation score were higher in observation group,while the differences had no statistical significance between two groups(P >0.05). At 1 year after the surgery, the maximum range of motion(ROM) of the knee joint in observation group was higher than that in control group(P <0.05). Conclusion For the treatment of tibial plateau fracture, ARIF could help surgeons find and treat soft tissue injuries more accurately, and has the advantages of less trauma and better recovery of knee joint ROM when compared to ORIF.
引文
[1]巴雪峰,孙改生,凯瑟尔,等.胫骨平台骨折的治疗新进展[J].中国矫形外科杂志,2012,20(12):1104-1107.
[2]Shao J,Chang H,Zhu Y,et al.Incidence and risk factors for surgical site infection after open reduction and internal fixation of tibial plateau fracture:a systematic review and meta-analysis[J].Int J Surg,2017,41:176-182.
[3]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.
[4]Chan YS.Arthroscopy-assisted surgery for tibial plateau fractures[J].Chang Guang Med J,2011,34(3):239-247.
[5]张希峰,李强,杨宗华,等.关节镜下复位内固定治疗胫骨平台骨折[J].国际骨科学杂志,2011,32(5):336-337.
[6]Schatzker J,Mc Broom R,Bruce D.The tibial plateau fracture:the Toronto experience 1968-1975[J].Clin Orthop Relat Res,1979(138):94-104.
[7]赵森,杨自权,卫小春.关节镜在胫骨平台骨折诊治中的应用[J].中国骨与关节杂志,2014,3(7):551-555.
[8]Rasmussen PS.Tibial condylar fractures:impairment of knee joint stability as an indication for surgical treatment[J].JBone Joint Surg Am,1973,55(7):1331-1350.
[9]Kiefer H,Zivaljevic N,Imbriglia JE.Arthroscopic reduction and internal fixation(ARIF)of lateral tibial plateau fractures[J].Knee Surg Sports Traumatol Arthrosc,2001,9(3):167-172.
[10]李冬尧,张会久,胡雅光.关节镜辅助下经皮内固定与传统切开复位内固定治疗SchatzkerⅠ~Ⅳ型胫骨平台骨折的疗效对比[J].中国内镜杂志,2017,23(6):58-65.
[11]Chan YS,Yuan LJ,Hung SS,et al.Arthroscopic-assisted reduction with bilateral buttress plate fixation of complex tibial plateau fractures[J].Arthroscopy,2003,19(9):974-984.
[12]王世坤,史宗新,丛云海,等.关节镜辅助复位内固定与传统切开复位内固定治疗胫骨平台骨折的比较研究[J].中国骨与关节损伤杂志,2017,32(6):595-597.
[13]赵吉连,尹占文,李明东,等.微创内固定治疗胫骨平台骨折的临床研究[J].中华关节外科杂志:电子版,2010,4(5):681-684.
[14]蔡海康,张银网,解品亮,等.关节镜辅助下锁定加压钢板微创治疗胫骨平台SchatzkerⅠ、Ⅱ、Ⅲ型骨折[J].现代预防医学,2011,38(10):1965-1966.
[15]Wang Z,Tang Z,Liu C,et al.Comparison of outcome of ARIF and ORIF in the treatment of tibial plateau fractures[J].Knee Surg Sports Traumatol Arthrosc,2017,25(2):578-583.
[16]Siegler J,Galissier B,Marcheix PS,et al.Percutaneous fixation of tibial plateau fractures under arthroscopy:a medium term perspective[J].Orthop Traumatol Surg Res,2011,97(1):44-50.
[17]Elabjer E,Ben?i?I,?uti T,et al.Tibial plateau fracture management:arthroscopically-assisted versus ORIF procedure-clinical and radiological comparison[J].Injury,2017,48(Suppl 5):S61-S64.
[18]Robertson GAJ,Wong SJ,Wood AM.Return to sport following tibial plateau fractures:a systematic review[J].World J Orthop,2017,8(7):574-587.
[19]Dall'oca C,Maluta T,Lavini F,et al.Tibial plateau fractures:compared outcomes between ARIF and ORIF[J].Strategies Trauma Limb Reconstr,2012,7(3):163-175.
[20]Abdel-Hamid MZ,Chang CH,Chan YS,et al.Arthroscopic evaluation of soft tissue injuries in tibial plateau fractures:retrospective analysis of 98 cases[J].Arthroscopy,2006,22(6):669-675.
[21]Metcalfe D,Hickson CJ,Mckee L,et al.External versus internal fixation for bicondylar tibial plateau fractures:systematic review and meta-analysis[J].J Orthop Traumatol,2015,16(4):275-285.
[22]陈星佐,林朋,刘成刚,等.关节镜辅助复位内固定治疗胫骨平台骨折的研究进展[J].中华创伤骨科杂志,2014,16(7):622-624.
[23]罗贝尔,陈晓,苏佳灿.胫骨平台骨折治疗进展[J].中国骨与关节损伤杂志,2011,26(12):1147-1148.
[2]Shao J,Chang H,Zhu Y,et al.Incidence and risk factors for surgical site infection after open reduction and internal fixation of tibial plateau fracture:a systematic review and meta-analysis[J].Int J Surg,2017,41:176-182.
[3]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.
[4]Chan YS.Arthroscopy-assisted surgery for tibial plateau fractures[J].Chang Guang Med J,2011,34(3):239-247.
[5]张希峰,李强,杨宗华,等.关节镜下复位内固定治疗胫骨平台骨折[J].国际骨科学杂志,2011,32(5):336-337.
[6]Schatzker J,Mc Broom R,Bruce D.The tibial plateau fracture:the Toronto experience 1968-1975[J].Clin Orthop Relat Res,1979(138):94-104.
[7]赵森,杨自权,卫小春.关节镜在胫骨平台骨折诊治中的应用[J].中国骨与关节杂志,2014,3(7):551-555.
[8]Rasmussen PS.Tibial condylar fractures:impairment of knee joint stability as an indication for surgical treatment[J].JBone Joint Surg Am,1973,55(7):1331-1350.
[9]Kiefer H,Zivaljevic N,Imbriglia JE.Arthroscopic reduction and internal fixation(ARIF)of lateral tibial plateau fractures[J].Knee Surg Sports Traumatol Arthrosc,2001,9(3):167-172.
[10]李冬尧,张会久,胡雅光.关节镜辅助下经皮内固定与传统切开复位内固定治疗SchatzkerⅠ~Ⅳ型胫骨平台骨折的疗效对比[J].中国内镜杂志,2017,23(6):58-65.
[11]Chan YS,Yuan LJ,Hung SS,et al.Arthroscopic-assisted reduction with bilateral buttress plate fixation of complex tibial plateau fractures[J].Arthroscopy,2003,19(9):974-984.
[12]王世坤,史宗新,丛云海,等.关节镜辅助复位内固定与传统切开复位内固定治疗胫骨平台骨折的比较研究[J].中国骨与关节损伤杂志,2017,32(6):595-597.
[13]赵吉连,尹占文,李明东,等.微创内固定治疗胫骨平台骨折的临床研究[J].中华关节外科杂志:电子版,2010,4(5):681-684.
[14]蔡海康,张银网,解品亮,等.关节镜辅助下锁定加压钢板微创治疗胫骨平台SchatzkerⅠ、Ⅱ、Ⅲ型骨折[J].现代预防医学,2011,38(10):1965-1966.
[15]Wang Z,Tang Z,Liu C,et al.Comparison of outcome of ARIF and ORIF in the treatment of tibial plateau fractures[J].Knee Surg Sports Traumatol Arthrosc,2017,25(2):578-583.
[16]Siegler J,Galissier B,Marcheix PS,et al.Percutaneous fixation of tibial plateau fractures under arthroscopy:a medium term perspective[J].Orthop Traumatol Surg Res,2011,97(1):44-50.
[17]Elabjer E,Ben?i?I,?uti T,et al.Tibial plateau fracture management:arthroscopically-assisted versus ORIF procedure-clinical and radiological comparison[J].Injury,2017,48(Suppl 5):S61-S64.
[18]Robertson GAJ,Wong SJ,Wood AM.Return to sport following tibial plateau fractures:a systematic review[J].World J Orthop,2017,8(7):574-587.
[19]Dall'oca C,Maluta T,Lavini F,et al.Tibial plateau fractures:compared outcomes between ARIF and ORIF[J].Strategies Trauma Limb Reconstr,2012,7(3):163-175.
[20]Abdel-Hamid MZ,Chang CH,Chan YS,et al.Arthroscopic evaluation of soft tissue injuries in tibial plateau fractures:retrospective analysis of 98 cases[J].Arthroscopy,2006,22(6):669-675.
[21]Metcalfe D,Hickson CJ,Mckee L,et al.External versus internal fixation for bicondylar tibial plateau fractures:systematic review and meta-analysis[J].J Orthop Traumatol,2015,16(4):275-285.
[22]陈星佐,林朋,刘成刚,等.关节镜辅助复位内固定治疗胫骨平台骨折的研究进展[J].中华创伤骨科杂志,2014,16(7):622-624.
[23]罗贝尔,陈晓,苏佳灿.胫骨平台骨折治疗进展[J].中国骨与关节损伤杂志,2011,26(12):1147-1148.