关节镜辅助下胫骨平台骨折的微创治疗  

Arthroscopically assisted treatment of tibial plateau fractures

作　　者：杨柳[1] 段小军[1] 郭林[1] 陈光兴[1] 唐康来[1] 

机构地区：[1]第三军医大学附属西南医院关节外科中心,重庆400038

出　　处：《中华创伤杂志》2005年第5期325-328,共4页Chinese Journal of Trauma

摘　　要：目的探讨在关节镜辅助下对胫骨平台骨折进行微创治疗的手术方法及近期疗效。方法自2002年2月至2004年3月,共治疗14例胫骨平台骨折,合并前交叉韧带止点撕脱骨折5例,半月板损伤4例;Schatzker分型为Ⅰ型2例,Ⅱ型4例,Ⅲ型3例,Ⅳ型4例,Ⅴ型1例。术前摄片和三维CT重建,术中在关节镜辅助下,首先对合并损伤进行相应处理,然后对骨折进行解剖复位,通过螺钉和克氏针等固定,最后C形臂X线机透视确认,术后坚持早锻炼、晚负重的原则。结果所有患者均在3-4个月骨性愈合,未出现切口愈合不良、感染和骨筋膜间隔综合症等早期并发症,在随访的8-15个月期间未观察到创伤性膝关节炎和膝关节内翻、外翻畸形。根据Ras-mussen评分,13例为优良,1例SchatzkerⅢ型为可,本组评分为26±3。结论在治疗SchatzkerⅠ-Ⅴ型胫骨平台骨折时,采用关节镜辅助下的有限切口结合少量固定的手术,具有创伤小、可同时处理关节腔内的其他损伤等优势,可以获得骨折愈合快、膝关节功能良好的近期疗效,因此值得推广应用。Objective To introduce a minimal surgical treatment of tibial plateau fractures under arthroscope and recent clinical outcome. Methods A total of 14 cases with tibial plateau fractures were treated by arthroscopic fixation from February 2002 to March 2004. Of all, five cases had associated bony avulsion of the anterior cruciate ligament and four had meniscal injury. There were two cases of type Ⅰ fracture, four type Ⅱ, three type Ⅲ, four type Ⅳ and one type Ⅴ based on Schatzker criteria. Before operation, X-ray examination and three-dimensional CT reconstruction were done. During operation, the combined injuries were treated firstly. Then, the dissociative fragments were managed with anatomic reduction and fixated with screws or nails. Finally, the internal fixation was observed by C-arm X-ray e-quipment. Postoperative management included early motion and delay weight bearing. Results All the fractures were healed within 3-4 months, with no severe complications such as poor wound healing, infection or osteofascial compartment syndrome. All patients that were followed up for 8-15 months showed no traumatic knee osteoarthritis, inversion or eversion of the knee. According to the Rasmussen scoring system 13 cases got excellent or good results but one average, with total score of 26± 3. Conclusions As for Schatzker type I-V tibial plateau fractures, arthroscopically assisted limit incision in combination with some fixation techniques is characterized by minimal invasion, fast fracture healing, sound knee joint function and worths further clinical application.

关 键 词：胫骨平台骨折 微创治疗 关节镜 Schatzker 前交叉韧带止点撕脱骨折 RASMUSSEN 骨筋膜间隔综合征 2004年3月 创伤性膝关节炎 三维CT重建 切口愈合不良 近期疗效 2002年 半月板损伤 X线机透视 早期并发症 膝关节功能 手术方法 

分 类 号：R687[医药卫生—骨科学]