关节镜辅助下治疗胫骨平台骨折38例  

Arthroscopically assisted treatment of tibial plateau fractures in 38 cases

作　　者：王铭春[1] 王治[1] 杨铁毅[1] 王思辉[1] 宋炜中 

机构地区：[1]上海市浦东新区公利医院骨科,上海200135

出　　处：《中国微创外科杂志》2006年第10期776-777,795,共3页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨关节镜辅助治疗胫骨平台骨折手术效果。方法胫骨平台骨折38例，包括Schatzker Ⅰ型8例，Ⅱ型10例，Ⅲ型11例，Ⅳ型4例，Ⅴ型3例，Ⅵ型2例。常规膝关节镜检查，合并半月板损伤15例，前交叉韧带部分或完全断裂12例，内侧副韧带损伤7例，在关节镜监视下进行复位和固定。对于Ⅰ～Ⅲ型骨折选用松质骨拉力螺钉固定，Ⅳ～Ⅵ型骨折则应用微创法植入支持钢板。结果本组手术时间30～72min，平均40min，术中出血量均少于20ml。术后36例随访4个月～3年，平均15个月。术后3个月X线片显示骨折均愈合，无切口及关节感染、皮肤坏死或创口延迟愈合。术后3个月HSS评分：优28例，良6例，中2例。此期主要表现为肌力不够及膝关节主动伸屈功能较差。术后6个月HSS评分：优33例，良3例。结论关节镜辅助治疗胫骨平台骨折，有助于骨折的正确复位和固定，并早期发现和处理关节内其他结构损伤。根据不同的骨折类型选用不同的内固定，能较好地微创处理多种类型的胫骨平台骨折。Objective To explore clinical results of arthroscopically assisted treatment for tibial plateau fractures. Methods Thirty-eight cases of tibial plateau fractures were treated under arthoscope. According to the Schatzker classification, there were 8 cases of type Ⅰ, 10 cases of type Ⅱ, 11 cases of type Ⅲ, 4 cases of type Ⅳ, 3 cases of type Ⅴ, and 2 cases of type Ⅵ, respectively. Routine arthoscopic examination of the knee found 15 cases of meniscus injury, 12 cases of partial or complete rupture of anterior cruciate ligament （ACL）, and 7 cases of medial collateral ligament （MCL） injury. Fracture reduction and fixation was performed under arthroscopic surveillance. The tibia plateau fracture was fixed with the cancellous bone screws （Schatzker Ⅰ～Ⅲ） or minimally invasive plate osteosynthesis （Schatzker Ⅳ～Ⅵ）. Results The operation time was 30～72 min （mean, 40 min） and the intraoperative blood loss was less than 20 ml. A follow-up was carried out in 36 cases for 4～36 months （mean, 15 months）. The X-ray findings at the 3 postoperative month showed bone union in all the 36 cases. There were no wound or joint infection, skin necrosis, or delayed union. The Hospital for Special Surgery （HSS） knee scores 3 months after operation revealed excellent results in 28 cases, good in 6 cases, and fair in 2. The main untoward manifestations at this period were lacking of muscle force and limited extension and incurvation of the knee joint. The HSS scores 6 months after operation showed excellent result in 33 cases and good in 3 cases. Conclusions Arthroscopically assisted treatment of tibial plateau fractures has advantages of accurate reduction and fixation and early detection and management of associated intraarticular injuries. Different methods of internal fixation should be chosen according to different types of facture.

关 键 词：胫骨平台 骨折 关节镜 微创 

分 类 号：R687[医药卫生—骨科学]