关节镜辅助下切开复位内固定治疗Schatzker Ⅰ~Ⅲ型胫骨平台骨折疗效分析  

Arthroscopic-assisted open reduction and internal fixation of Schatzker typeⅠ-Ⅲtibial plateau fractures

作　　者：周银 曹鎏 周锋 刘斌 李娜 Zhou Yin;Cao Liu;Zhou Feng;Liu Bin;Li Na(Department of Emergency,General Hospital of Xinjiang Military Command,Urumqi 830000,China)

机构地区：[1]中国人民解放军新疆军区总医院急诊科,乌鲁木齐830000

出　　处：《创伤外科杂志》2025年第4期272-276,共5页Journal of Traumatic Surgery

摘　　要：目的 研究关节镜辅助下切开复位内固定治疗SchatzkerⅠ~Ⅲ型胫骨平台骨折(TPF)的疗效。方法 前瞻性选择2021年1月—2023年12月于中国人民解放军新疆军区总医院急诊科治疗的86例SchatzkerⅠ~Ⅲ型TPF患者临床资料,按照随机数字表法分为观察组(n=43)和对照组(n=43)。观察组男性32例,女性11例;年龄23~48岁,平均29.6岁;致伤机制:道路交通伤26例,跌落伤15例,其他2例。对照组男性34例,女性9例;年龄23~47岁,平均29.8岁;致伤机制:道路交通伤27例,跌落伤14例,其他2例。患者均符合《胫骨平台骨折诊断与治疗的专家共识》中SchatzkerⅠ~Ⅲ型TPF诊断标准。对照组行切开复位内固定,观察组行关节镜辅助下切开复位内固定治疗。观察两组手术相关指标,术后即刻、术后6个月膝关节活动度(ROM)及膝关节功能、术后并发症及临床疗效。结果 观察组切口长度、术中出血量、手术时间、下床活动时间、切口愈合时间、骨折愈合时间均少于对照组[(3.22±0.34)cm vs.(6.07±0.62)cm,(59.0±6.2)mL vs.(90.2±9.2)mL,(91.4±9.4)min vs.(104.1±12.2)min,(3.7±0.4)d vs.(5.7±0.6)d,(10.3±1.2)d vs.(14.4±1.7)d,(85.4±8.7)d vs.(101.8±12.4)d],差异有统计学意义(P<0.05)。两组术后并发症发生率(2.3%vs.9.3%)比较差异无统计学意义(P>0.05)。术后6个月,两组膝关节屈曲ROM、伸直ROM及Rasmussen评分、HSS评分均大于术后即刻,差异有统计学意义(P<0.05)。两组优良率比较差异无统计学意义(86.1%vs.88.3%,P>0.05)。结论 关节镜辅助下切开复位内固定治疗SchatzkerⅠ~Ⅲ型TPF患者可减小手术创伤,减少术后并发症,增大膝关节活动度,改善膝关节功能,且疗效与切开复位内固定一致。Objective To assess the effect of arthroscopic-assisted open reduction and internal fixation for Schatzker typeⅠ-Ⅲtibial plateau fractures(TPF).Methods A total of 86 patients with confirmed Schatzker typeⅠ-ⅢTPF treated in our hospital from Jan.2021 to Dec.2023 were prospectively selected and divided into an observation group(n=43)and a control group(n=43)according to the random number table method.In the observation group,there were 32 males and 11 females,aged 23 to 48 years,with an average of 29.6 years.The injury mechanism was as follows:26 cases of road traffic injuries,15 falls,and 2 others.In the control group,there were 34 males and 9 females,aged 23 to 47 years,with an average of 29.8 years.The injury mechanism was as follows:27 cases of road traffic injuries,14 falls,and 2 others.The control group underwent open reduction and internal fixation,while the observation group underwent arthroscopic-assisted open reduction and internal fixation.The surgery-related indicators,knee range of motion(ROM)and knee function immediately after surgery and 6 months postoperatively,postoperative complications,and other clinical outcomes were observed in both groups.The factors affecting the prognosis of patients were analyzed.Results The observation group showed much shorter incision length(cm,3.22±0.34 vs.6.07±0.62),and less intraoperative blood loss(mL,59.0±6.2 vs.90.2±9.2),operation time(min,91.4±9.4 vs.104.1±12.2),off-bed activity time(d,3.7±0.4 vs.5.7±0.6),incision healing time(d,10.3±1.2 vs.14.4±1.7)and fracture healing time(85.4±8.7 vs.101.8±12.4),all revealing significant difference with the control group(P<0.05).The incidence of postoperative complications in observation and control groups showed no significant difference(2.3%vs.9.3%,P>0.05).At 6 months postoperatively,the knee flexion ROM,extension ROM,Rasmussen score,and HSS score in both observation and control groups were much higher than those immediately after surgery,indicating significant differences(all P<0.05),but comparison between

关 键 词：胫骨平台骨折 关节镜 治疗 预后 

分 类 号：R683.42[医药卫生—骨科学]