胫骨平台骨折关节镜下复位内固定  

Arthroscopic reduction and internal fixation for treatment of tibial plateau fractures

作　　者：李璐兵 李飞[2] 阿依丁 韩然 LI Lu-bing;LI Fei;A Yi-ding;HAN Ran(Department of Osteology,Tianfu Hospital,the Seventh People's Hospital of Chengdu,Chengdu610203,China;The Sixth Affiliated Hospital,Xinjiang Medical University,Urumqi830002,China)

机构地区：[1]成都市第七人民医院天府院区骨一科,四川成都610203 [2]新疆医科大学第六附属医院,新疆乌鲁木齐830002

出　　处：《中国矫形外科杂志》2023年第4期325-330,共6页Orthopedic Journal of China

摘　　要：[目的]探讨前外侧入路膝关节镜下复位内固定(arthroscopic reduction and internal fixation,ARIF)治疗胫骨平台骨折的效果。[方法]回顾性分析2018年1月—2020年1月,手术治疗的胫骨平台骨折95例患者的临床资料。其中,49例采用前外侧入路ARIF治疗,46例常规切开复位内固定术(open reduction and internal fixation,ORIF)。比较两组围手术期情况,随访结果和影像资料。[结果]两组均顺利完成手术,无重要血管、神经、半月板等医源性损伤。ARIF组切口长度、手术时间、术中出血量、透视次数、术后引流量、术后下地时间、住院时间和术后3 d VAS评分均显著优于ORIF组(P<0.05)。两组患者术后均获随访12~24个月,平均(16.5±3.6)个月。不良事件,ARIF组为1/49(2.0%),ORIF组8/46(17.4%),差异有统计学意义(P<0.05)。ARIF组术后完全负重时间显著早于ORIF组(P<0.05)。术后3个月及末次随访时,ARIF组的HSS评分、Lysholm评分、Rasmussen功能评分均显著高于ORIF组,膝关节活动最大屈曲及过伸ROM均显著高于ORIF组,差异均有统计学意义(P<0.05)。影像学方面,术后即刻及末次随访时ARIF组的Rasmussen解剖评分均显著高于ORIF组(P<0.05)。与术前相比,术后即刻及末次随访时两组的关节面塌陷均显著降低(P<0.05);但是术后即刻与未次随访时,ARIF组的关节面塌陷显著小于ORIF组(P<0.05)。[结论]膝关节镜下复位内固定胫骨平台骨折的临床效果明显优于开放复位内固定。[Objective]To explore the clinical outcomes arthroscopic reduction and internal fixation(ARIF)through the anterolateral approach for treatment of tibial plateau fractures.[Methods]A retrospective study was done on 95 patients who underwent surgical treat⁃ment for tibial plateau fractures from January 2018 to January 2020 in our hospital.Among them,49 patients receive ARIF through antero⁃lateral approach,while the remaining 46 patients were treated with conventional open reduction and internal fixation(ORIF)according to the consequence of preoperative patient-doctor communication.The perioperative conditions,follow-up results and imaging data were com⁃pared between the two groups.[Results]All patients in both groups were successfully operated on without iatrogenic injuries to important blood vessels,nerves and meniscus.The ARIF group proved significantly superior to the ORIF group in terms of incision length,operative time,intraoperative blood loss,frequency of fluoroscopy,postoperative drainage,time to return ambulation with crutches,hospital stay and VAS score 3 days postoperatively(P<0.05).All patients in both groups were followed up for 12~24 months,with an average of(16.5±3.6)months.Adverse events were 1/49(2.0%)in the ARIF group,whereas 8/46(17.4%)in the ORIF group,which was statistically significant(P<0.05).The ARIF group resumed full weight-bearing activity significantly earlier than the ORIF group(P<0.05).In addition,the ARIF group was significantly superior to the ORIF group in terms of HSS,Lysholm and Rasmussen function scores,as well as knee flexion and ex⁃tension range of motions(ROMs)at 3 months and the latest follow-up(P<0.05).Regarding to radiographic evaluation,the ARIF group had significantly higher Rasmussen anatomical scores than the ORIF group immediately after surgery and at the latest follow-up(P<0.05).The articular surface collapse was significantly reduced in both groups immediately after surgery and at the last follow-up compared with those before operation(P<0.05),whereas which

关 键 词：胫骨平台骨折 关节面塌陷 膝关节镜 内固定术 

分 类 号：R683.42[医药卫生—骨科学]