关节镜及C臂X射线机导航下内固定治疗膝关节周围骨折50例  

Internal fixation guided by arthroscopy and C-arm X-ray scanning for knee-joint peripheral fractures in 50 cases

作　　者：金先跃[1] 李宏宇[1] 王玮[2] 吴成宾 

机构地区：[1]广西壮族自治区人民医院骨科,广西壮族自治区南宁市530021 [2]广西壮族自治区民族医院骨科,广西壮族自治区南宁市530001 [3]广西武鸣县人民医院骨科,广西壮族自治区南宁市530001

出　　处：《中国组织工程研究与临床康复》2008年第48期9511-9514,共4页Journal of Clinical Rehabilitative Tissue Engineering Research

摘　　要：背景:切开复位治疗膝关节周围骨折,复位后易发生感染、出血、粘连、疼痛、关节囊挛缩等并发症,增加骨不连的发生率。目的:评价关节镜及C臂X射线机导航下内固定治疗膝关节周围骨折的临床疗效。设计、时间及地点:病例观察,实验于2005-04/2008-04在广西壮族自治区人民医院和广西壮族自治区民族医院完成。对象:选择同期广西壮族自治区人民医院和广西壮族自治区民族医院闭合性膝关节周围骨折患者50例。男29例,女21例;年龄18～75岁,平均41岁。方法:采用关节镜及C臂X射线机导航下内固定膝关节周围骨折。其中胫骨髁间嵴骨折9例,采用钢丝及可吸收螺钉内固定;胫骨平台骨折11例,采用空心螺钉内固定;髌骨骨折30例,采用空心螺钉+张力带钢丝内固定。主要观察指标:①内固定后X射线片结果。②HSS膝关节功能评分。③不良事件及副反应。结果:最短随访5个月,最长随访3年,50例患者全部进入结果分析。术后复查X射线片显示:骨折对位、对线良好。所有患者骨折愈合良好,关节屈伸功能恢复良好。50例平均HSS评分为(96.3±1.2)分。仅3例术后持续轻微疼痛,余无材料宿主反应及并发症。结论:关节镜结合C臂X射线机透视下内固定治疗膝关节周围骨折,不仅改善了传统手术创伤大、出血多、术后关节粘连、瘢痕挛缩、术中容易漏诊等缺点,而且能够保证骨折获得精确的解剖复位,同时可以对膝关节内进行全面的检查,修复关节内损伤的半月板、滑膜、关节软骨等,全面提高了临床疗效。BACKGROUND： Incision reduction is used to treat knee-joint peripheral fractures. However, its complications such as infection, bleeding, adhesion, pain, contracture of articular capsula increase incidence rate of bone nounion. OBJECTIVE： To evaluate the clinical effects of internal fixation guided by arthroscopy and C-ann X-rays scanning on knee-joint peripheral fractures. DESIGN, TIME AND SETTING： Case observation. The experiment was performed at the People＇s Hospital of Guangxi Zhuang Autonomous Region and Guangxi Minzu Hospital between April 2005 and April 2008. PARTICIPANTS： Fifty cases of knee-joint peripheral fractures were selected including 29 males and 21 females with an average age of 41 years （range 18 75 years）. METHODS： Fifty cases of knee-joint peripheral fractures were treated with internal fixation under the guidance by arthroscopy and C-arm X-rays scanning.Among them, 9 cases of tibial intercondylar eminentia fracture were treated with steel wires and absorbable screws fixation; 11 cases of tibial plateau fracture were treated with hollow screws fixation; 30 cases of patellar fracture were treated with hollow screws ＋tension steel wires. MAIN OUTCOME MEASURES： X-ray results following internal fixation; Hospital for Special Surgery （HSS） knee score of knee joint; adverse reactions. RESULTS： Fifty cases were followed for 5 months to 3 years. All cases were included in the final analysis. The postoperative X-ray films showed satisfactory counterpoint and counterline of fracture. All cases showed good fracture healing, and improved joint flexion function. HSS mean scores of 50 cases were （96.3±1.2）. Except three cases developed continuous pain, no material-host reactions or complications were found. CONCLUSION： Internal fixation guiding by arthroscopy and C-ann X-rays scanning could improve the defects of traditional operation such as large wound, large bleeding, joint adhesion postoperatively, cicatricial contraction, perioperative missed diagnosis, and could ensure

关 键 词：关节镜 C臂X射线机 内固定 膝关节 骨折 

分 类 号：R683[医药卫生—骨科学]