关节镜在治疗各型胫骨平台骨折的临床应用  

Arthroscopic Assisted Management of Tibial Plateau Fracture

作　　者：邵安泽[1] 岳洋[1] 潘长军[1] 王贯中[1] 

机构地区：[1]江苏省连云港市第二人民医院骨科,江苏连云港222023

出　　处：《河北医学》2007年第11期1307-1310,共4页Hebei Medicine

摘　　要：目的：探讨关节镜在治疗胫骨平台骨折中的临床应用。方法：自2003年4月至2006年10月间,应用关节镜治疗胫骨平台骨折28例,男18例,女10例,平均年龄40.6岁,按Schatzker分型Ⅰ型7例,Ⅱ型8例,Ⅲ型6例,Ⅳ型2例,Ⅴ型2例,Ⅵ型3例。术后随访时间8-26个月,平均14.6个月,取得了良好的效果。结果：无1例出现需要处理的术后并发症,23例SchatzkerIV及以下型骨折,仅1例考虑到稳定的需要使用平台外侧解剖钢板,其余22例均只以两枚松质骨螺钉固定,对于其他5例SchatzkerⅤ、Ⅵ型骨折,则在关节镜及C臂机辅助下复位,使用单侧或双侧钢板固定。随访后X线片显示26病人关节面残留台阶均小于2mm,无骨性关节炎的表现,1例病人出现外侧平台的再塌陷。按照Lysholm膝关节评分标准,28例病人平均92.4分（78-96分）,膝关节活动度平均118°（100°-130°）。结论：尽管关节镜难以成为治疗胫骨平台骨折的常规治疗手段,对其在临床的运用和认识也都处于探索的阶段,但由于对患者因手术而获得的再次损伤很小,符合微创的理念和原则,且在术后的恢复,术中伤情的判断,临床结果等方面均有独特的优势,因此在合适的患者群中值得优先考虑。Objective： To discuss the clinical application with arthroscopic assisted management in tibial plateau fracture. Method： From 2003 to 2006, 28 cases of the tibial plateau fracture were treated with arthroscopie assisted management. There were 18 males and 10 females averge 40.6 years old. 7 cases for Ⅰ , 8 cases for Ⅱ , 6 cases for Ⅲ,2 cases for Ⅳ, 2 cases for Ⅴ and 3 for Ⅵ according to Schatzker classifaction. At a mean follow - up for 14.6 months（ 8 to 26 months）, we gained the perfect results. Result： There were no postoperative complications demanding surgical disposal among all cases. Among 23 patients with tibial plateau fracture below Schatzker Ⅳ, 22 cases were fixed with 2 leg screws, and only one for Schatzker Ⅲ with anatomic plate. For the other 5 cases for Schatzker V. Ⅵ, replaced with asistant of arthroscopic, then fixed with single or double side plates. No radiological signs of manifest osteoarthfitis in all cases. According to Lysholm scale of knee joint, 92.4 score for average and average range of motion for 118°. Conclusion： Although arthroscope assisted is difficult to become the conventional management treating tibial plateau fracture, secondary injuries on patient obtained from operation is tiny which consistent with the concep- tion of the minimal invaslve. Furthermore, there are distinctive advantages in posteroperative rehabilitation, judgement of the injury and clinical outcome etc. Arthroscopic assisted management deserve the preferential recommendation among the suitable patients suffer from tibial plateau fracture.

关 键 词：关节镜 胫骨平台骨折 

分 类 号：R687.3[医药卫生—骨科学]