关节镜下经皮复位内固定术治疗胫骨外侧平台骨折的中远期疗效分析  

The mid⁃and long⁃term effect of arthroscopic percutaneous internal fixation for tibial plateau fractures

作　　者：王徐龙 要鹏 王琪 WANG Xulong;YAO Peng;WANG Qi(Department of Orthopedic,The Second People’s Hospital of Zhangye City,Zhangye 734000,China)

机构地区：[1]甘肃省张掖市第二人民医院骨科,734000 [2]甘肃省张掖市第二人民医院关节外科,734000

出　　处：《临床外科杂志》2023年第12期1200-1204,共5页Journal of Clinical Surgery

摘　　要：目的探讨关节镜下经皮复位内固定术治疗胫骨外侧平台骨折的中远期疗效。方法我院2005年5月~2015年5月行关节镜下经皮复位内固定术治疗胫骨外侧平台骨折并接受随访至少3年的病人31例,记录术后6个月及末次随访膝关节Lysholm评分、Tegner运动水平评分、Rasmussen功能评分、膝关节Rasmussen放射学评分及Ahlback骨关节炎分级情况。结果所有病人骨折均行一期手术并实现骨性愈合,未出现不愈合及畸形愈合。术后3例病人出现了膝关节僵硬,其中2例通过理疗结合康复锻炼后明显改善,1例术后6个月确认骨折愈合后进行关节镜下软组织松解术,术后膝关节获得了满意的活动范围。31例病人均获得了随访,最短随访3年,平均随访时间(56.90±17.03)个月,末次随访Lysholm评分、Tegner评分及Rasmussen功能评分与术后6个月随访比较差异无统计学意义(P>0.05)。末次随访所有病人膝关节屈曲(132.06±4.89)°,过伸(1.55±2.84)°。末次随访与术后6个月膝关节Rasmussen放射学评分、Ahlback骨关节炎分级比较差异均有统计学意义(P<0.05);在下肢全长负重位X线片上,将患侧与健侧相比较发现,末次随访与术后6个月比较,下肢轴向力线平均旋转角度比较差异有统计学意义(P<0.05),末次随访6例膝关节出现外翻偏斜,2例出现内翻偏斜。病人接受手术时年龄(>50岁)及术中发现骨折合并关节内软组织损伤是影响骨性关节炎发生的因素(P<0.05)。结论接受关节镜下经皮复位内固定术治疗胫骨外侧平台骨折的病人,在术后中远期随访时的Lysholm评分、Teg⁃ner评分及Rasmussen评分等表现膝关节整体功能的评分尚满意,继发性骨关节炎发病率低于文献报道的接受切开复位内固定术者,年龄(>50岁)及骨折合并关节内软组织损伤病人疗效欠佳。Objective To investigate the mid⁃and long⁃term effect of arthroscopic percutaneous internal fixation for the treatment of tibial plateau fractures.Methods 31 patients with tibial plateau fractures treated by arthroscopic percutaneous internal fixation from May 2005 to May 2015 were followed up for a minimum of 3 years.The Lysholm score,Tegner motor level score,Rasmussen functional score,Rasmussen radiological score and Ahlback osteoarthritis classification of the knee joints were recorded at 6 months and the last follow⁃up.Results Bone union was achieved in all patients,and no nonunion or malunion occurred.There were 3 cases of stiffness of knee joint after operation,2 cases of them were improved after physiotherapy combined with rehabilitation exercise,1 case underwent arthroscopic soft tissue release after 6 months of operation to confirm fracture healing,and the range of motion of knee joint was satisfactory after operation.All patients were followed up,with a minimum follow⁃up of 3 years and an average follow⁃up time of(56.90±17.03)months.There was no significant difference in Lysholm score,Tegner score and Rasmussen score between the last follow⁃up and 6 months after operation in all patients(P>0.05).At the last follow⁃up,the knee flexion and extension were(132.06±4.89°and 1.55±2.84)°,respectively.There was significant difference in Rasmussen radiological score of knee joint and Ahlback osteoarthritis classification between the last follow⁃up and 6 months after operation(P<0.05).Compared the affected side with the healthy side on the full⁃length weight⁃bearing X⁃ray film of lower extremity,it was found that the average rotation angle of the axial force line of lower extremity was significantly different between the last follow⁃up and 6 months after operation(P<0.05).At the last follow⁃up,among the 31 patients,6 had valgus deflection and 2 had varus deflection.Age and intra⁃articular soft tissue injury were factors for osteoarthritis(P<0.05).Conclusion For patients who receive

关 键 词：胫骨平台骨折 关节镜 内固定 闭合复位 Lysholm评分 Tegner评分 Rasmussen评分 

分 类 号：R687.3[医药卫生—骨科学]