关节镜下内固定与切开复位内固定治疗低能量胫骨平台骨折的对比研究
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摘要
目的比较关节镜下内固定与切开复位内固定治疗低能量胫骨平台骨折的疗效。方法选择2011年11月至2012年11月延安市人民医院和榆林市第一医院接受手术治疗的低能量胫骨平台骨折患者218例作为研究对象,采用随机数字表法分为关节镜组和切开复位组,每组109例。关节镜组接受关节镜下内固定治疗,切开复位组接受切开复位内固定治疗。观察两组患者的手术相关指标,采用美国膝关节协会评分(AKSS)系统评价膝关节功能,通过X线检查测量伸膝最大角度及屈膝最大角度来反映关节活动度。结果关节镜组的手术时间及总住院时间显著短于切开复位组[(52±11)min比(82±22)min,(5.4±1.2)d比(9.3±3.2)d,P<0.01],术中出血量及术后引流量显著少于切开复位组[(22±7)m L比(63±11)m L,(14±3)m L比(24±5)m L,P<0.01]。与切开复位组比较,关节镜组术后8、16、24周时,膝关节伸膝最大角度[(-0.3±0.1)°比(-0.2±0.1)°,(-0.6±0.2)°比(-0.3±0.1)°,(-0.6±0.2)°比(-0.4±0.1)°,P<0.05]、屈膝最大角度[(116±5)°比(102±4)°,(130±8)°比(112±6)°,(132±5)°比(119±6)°,P<0.05]均显著大于切开复位组。术后6、9、12个月时,AKSS膝关节功能评分均显著高于切开复位组[(158±20)分比(127±24)分,(168±17)分比(137±17)分,(187±11)分比(152±17)分,P<0.05]。结论关节镜下内固定治疗可以有效减少胫骨平台患者的手术创伤、优化手术指标,且加速患者的术后康复、提高膝关节功能及活动度。
Objective To compare the effect between arthroscopic fixation and ORIF on low-energy tibial plateau fractures. Methods A total of 218 patients with low-energy tibial plateau fractures underwent surgical treatment in Yan'an People's Hospital and Yulin First Hospital from Nov. 2011 to Nov. 2012 were selectd as research objects,and randomly divided into arthroscopy group and open reduction group,with 109 cases in each group. Patients in arthroscopy group received arthroscopic internal fixation treatment,while patients in open reduction group received open reduction and internal fixation treatment. Then surgery-related indicators were observed,and knee function were evaluated by American Knee Society Sore( AKSS),knee maximum extension angle and maximum flexion angle were measured by X-ray to reflect the joint mobility. Results The operation time and duration of hospital stay of the arthroscopy group were significantly shorter than the open reduction group[( 52 ± 11) min vs( 82 ± 22) min,( 5. 4 ± 1. 2) d vs( 9. 3 ± 3. 2) d,P < 0. 01 ],while volumns of intraoperative bleeding and postoperative drainage were significantly less than the open reduction group[( 22 ± 7) m L vs( 63 ± 11) m L,( 14 ± 3) m L vs( 24 ± 5) m L,P < 0. 05]; 8,16,24 weeks after surgery,the maximum angles of knee extension of the arthroscopy group were significantly higher than the open reduction group [(- 0. 3 ± 0. 1) ° vs(- 0. 2 ± 0. 1) °,(- 0. 6 ± 0. 2) ° vs(- 0. 3 ± 0. 1) °,(- 0. 6 ± 0. 2) ° vs(- 0. 4 ± 0. 1) °,P < 0. 05] and the maximum angle of knee flexion were also significantly higher than the open reduction group[( 116 ± 5) ° vs( 102 ± 4) °,( 130 ± 8) ° vs( 112 ± 6) °,( 132 ±5) ° vs( 119 ± 6) °,P < 0. 05]; 6,9,12 months after operation,AKSS knee function scores of the arthroscopy group were significantly higher than open reduction group[( 158 ± 20) scores vs( 127 ± 24) scores,( 168 ±17) scores vs( 137 ± 17) scores,( 187 ± 11) scores vs( 152 ± 17) scores,P < 0. 05]. Conclusion Arthroscopic fixation can effectively reduce surgical trauma of patients with tibial plateau,optimize surgical targets,accelerate postoperative rehabilitation of the patients and improve the knee function and mobility.
Objective To compare the effect between arthroscopic fixation and ORIF on low-energy tibial plateau fractures. Methods A total of 218 patients with low-energy tibial plateau fractures underwent surgical treatment in Yan'an People's Hospital and Yulin First Hospital from Nov. 2011 to Nov. 2012 were selectd as research objects,and randomly divided into arthroscopy group and open reduction group,with 109 cases in each group. Patients in arthroscopy group received arthroscopic internal fixation treatment,while patients in open reduction group received open reduction and internal fixation treatment. Then surgery-related indicators were observed,and knee function were evaluated by American Knee Society Sore( AKSS),knee maximum extension angle and maximum flexion angle were measured by X-ray to reflect the joint mobility. Results The operation time and duration of hospital stay of the arthroscopy group were significantly shorter than the open reduction group[( 52 ± 11) min vs( 82 ± 22) min,( 5. 4 ± 1. 2) d vs( 9. 3 ± 3. 2) d,P < 0. 01 ],while volumns of intraoperative bleeding and postoperative drainage were significantly less than the open reduction group[( 22 ± 7) m L vs( 63 ± 11) m L,( 14 ± 3) m L vs( 24 ± 5) m L,P < 0. 05]; 8,16,24 weeks after surgery,the maximum angles of knee extension of the arthroscopy group were significantly higher than the open reduction group [(- 0. 3 ± 0. 1) ° vs(- 0. 2 ± 0. 1) °,(- 0. 6 ± 0. 2) ° vs(- 0. 3 ± 0. 1) °,(- 0. 6 ± 0. 2) ° vs(- 0. 4 ± 0. 1) °,P < 0. 05] and the maximum angle of knee flexion were also significantly higher than the open reduction group[( 116 ± 5) ° vs( 102 ± 4) °,( 130 ± 8) ° vs( 112 ± 6) °,( 132 ±5) ° vs( 119 ± 6) °,P < 0. 05]; 6,9,12 months after operation,AKSS knee function scores of the arthroscopy group were significantly higher than open reduction group[( 158 ± 20) scores vs( 127 ± 24) scores,( 168 ±17) scores vs( 137 ± 17) scores,( 187 ± 11) scores vs( 152 ± 17) scores,P < 0. 05]. Conclusion Arthroscopic fixation can effectively reduce surgical trauma of patients with tibial plateau,optimize surgical targets,accelerate postoperative rehabilitation of the patients and improve the knee function and mobility.
引文
[1]杨顺,郭院生,韩书勇.C臂机监视下微创钢板内固定治疗低能量胫骨平台骨折68例分析[J].中国误诊学杂志,2010,10(19):4700-4701.
[2]陆小平.低能量胫骨平台骨折采用关节镜下微创内固定治疗24例[J].江西医药,2011,46(8):725-727.
[3]Blakey CM,Rennison M,Guy SP,et al.A biomechanical study comparing two fixation methods in depression fractures of the lateral tibial plateau in porcine bone[J].BMC Sports Sci Med Rehabil,2013,5(1):15-19.
[4]王东莉.关节镜辅助观察用于低能量胫骨平台骨折的手术治疗[J].医药论坛杂志,2010,31(19):173-174.
[5]蔡海康,张银网,解品亮.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):1965-1969.
[6]顾爱群,孙旭,唐炬.关节镜及C型臂X线机双重监视下微创治疗胫骨平台低能量骨折[J].中国医药指南,2010,8(36):191-194.
[7]Laible C,Earl-Royal E,Davidovitch R,et al.Infection after spanning external fixation for high-energy tibial plateau fractures:is pin site-plate overlap a problem?[J].J Orthop Trauma,2012,26(2):92-97.
[8]钟梅艳,王玮,庄小强.关节镜监视下微创经皮螺丝钉内固定治疗低能量胫骨平台骨折围手术期护理[J].护士进修杂志,2008,23(16):1471-1473.
[9]王玮,庄小强,金先跃.关节镜监视下微创经皮螺丝钉内固定治疗低能量胫骨平台骨折[J].中国内镜杂志,2009,15(1):97-99.
[10]Oztürkmen Y,Caniklioˇglu M,Karamehmetoˇglu M,et al.Calcium phosphate cement augmentation in the treatment of depressed tibial plateau fractures with open reduction and internal fixation[J].Acta Orthop Traumatol Turc,2010,44(4):262-269.
[11]王玮,金先跃,庄小强.关节镜监视与切开复位钢板内固定治疗低能量胫骨平台骨折的疗效比较[J].中国内镜杂志,2013,19(4):359-362.
[12]周自广.关节镜下经皮复位空心钉内固定治疗低能量胫骨平台骨折[J].中国修复重建外科杂志,2009,23(11):1316-1318.
[13]Werner CM,Scheyerer MJ,Schmitt J,et al.Minimally invasive balloon-assisted reduction and internal fixation of tibial plateau fractures[J].Unfallchirurg,2012,115(12):1126-1132.
[14]Weaver MJ,Harris MB,Strom AC,et al.Fracture pattern and fixation type related to loss of reduction in bicondylar tibial plateau fractures[J].Injury,2012,43(6):864-869.
[2]陆小平.低能量胫骨平台骨折采用关节镜下微创内固定治疗24例[J].江西医药,2011,46(8):725-727.
[3]Blakey CM,Rennison M,Guy SP,et al.A biomechanical study comparing two fixation methods in depression fractures of the lateral tibial plateau in porcine bone[J].BMC Sports Sci Med Rehabil,2013,5(1):15-19.
[4]王东莉.关节镜辅助观察用于低能量胫骨平台骨折的手术治疗[J].医药论坛杂志,2010,31(19):173-174.
[5]蔡海康,张银网,解品亮.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):1965-1969.
[6]顾爱群,孙旭,唐炬.关节镜及C型臂X线机双重监视下微创治疗胫骨平台低能量骨折[J].中国医药指南,2010,8(36):191-194.
[7]Laible C,Earl-Royal E,Davidovitch R,et al.Infection after spanning external fixation for high-energy tibial plateau fractures:is pin site-plate overlap a problem?[J].J Orthop Trauma,2012,26(2):92-97.
[8]钟梅艳,王玮,庄小强.关节镜监视下微创经皮螺丝钉内固定治疗低能量胫骨平台骨折围手术期护理[J].护士进修杂志,2008,23(16):1471-1473.
[9]王玮,庄小强,金先跃.关节镜监视下微创经皮螺丝钉内固定治疗低能量胫骨平台骨折[J].中国内镜杂志,2009,15(1):97-99.
[10]Oztürkmen Y,Caniklioˇglu M,Karamehmetoˇglu M,et al.Calcium phosphate cement augmentation in the treatment of depressed tibial plateau fractures with open reduction and internal fixation[J].Acta Orthop Traumatol Turc,2010,44(4):262-269.
[11]王玮,金先跃,庄小强.关节镜监视与切开复位钢板内固定治疗低能量胫骨平台骨折的疗效比较[J].中国内镜杂志,2013,19(4):359-362.
[12]周自广.关节镜下经皮复位空心钉内固定治疗低能量胫骨平台骨折[J].中国修复重建外科杂志,2009,23(11):1316-1318.
[13]Werner CM,Scheyerer MJ,Schmitt J,et al.Minimally invasive balloon-assisted reduction and internal fixation of tibial plateau fractures[J].Unfallchirurg,2012,115(12):1126-1132.
[14]Weaver MJ,Harris MB,Strom AC,et al.Fracture pattern and fixation type related to loss of reduction in bicondylar tibial plateau fractures[J].Injury,2012,43(6):864-869.