关节镜辅助下微创治疗胫骨平台骨折27例围手术期护理  

Arthroscopically assisted treatment of tibial plateau fractures

作　　者：黄合琴[1] 邓姝[1] 韩琳[1] 

机构地区：[1]第三军医大学西南医院关节外科中心,重庆400038

出　　处：《重庆医学》2006年第13期1165-1167,共3页Chongqing medicine

摘　　要：目的总结在关节镜辅助下对胫骨平台骨折进行微创治疗的围手术期护理方法及近期疗效。方法2002年2月～2005年7月，共治疗27例胫骨平台骨折，合并前交叉韧带止点撕脱骨折、半月板损伤和侧副韧带损伤等共10例。常规行术前摄片和三维CT重建，石膏托固定或胫骨结节骨牵引术，惠肢肿胀减轻后即在关节镜辅助下手术，术后抬高患肢，并短期固定和局部冰敷，及时复查X线平片，坚持早锻炼、晚负重的原则，最后做好出院指导。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、感染和骨筋膜间室综合征等早期并发症。在随访的8～24个月期间未观察到创伤性膝关节炎和明显的膝关节内翻、外翻畸形，根据Rasmussen评分，23例病例为优良，4例Schatzker Ⅲ型为可，本组总评分为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，及时准确的围手术期护理对确保手术疗效和防止手术并发症起到了积极的促进作用。Objective To introduce a minimal surgical treatment of tibial plateau fractures under arthroscope and its corresponding clinical outcome. Methods A total of 27 patients with tibial plateau fractures were treated by arthroscopic fixation between February 2002 and July 2005 and 10 patients had associated bony avulsion of the anterior cruciate ligament and meniscal injury. The internal fixation was observed by X-ray examination. Postoperative management was early motion and delayed weight bearing. Results All the fractures were healing in 3 or 4 months. All patients were available from 8 to 24 months follow-up. No case had severe complication, such as poor wound healing, infection, osteofascial compartment syndrome and osteoarthritis. According to the Rasmussen scoring system, 23 cases were excellent or good results and four cases were common result, the mean score was 26±3. Conclusion Arthroscopy is the treatment of choice for tibial plateau fractures. Advantages of this technique are minimal invasive, simple procedure, less time for operation and hospitalization with early rehabilitation, and all the combined injuries can be treated at the same time.

关 键 词：胫骨平台骨折 关节镜 治疗 护理 

分 类 号：R473.6[医药卫生—护理学]