膝关节镜辅助下内固定和传统切开手术治疗后外侧胫骨平台骨折的效果对比

傅升培

[摘要] 目的 研究膝关节镜辅助下内固定和传统切开手术治疗后外侧胫骨平台骨折的治疗效果。 方法 选取2013年1月～2015年6月在我院住院治疗后外侧胫骨平台骨折患者85例，按照患者自愿选择方法将入组患者分为两组，对照组41例患者，观察组44例患者，观察组患者使用膝关节镜辅助下内固定治疗方法，传统切开手术治疗方法应用与对照组患者，观察两组患者一般特征情况（手术时间、住院时间、切口长度、切口和骨愈合时间），比较两组患者RASMUSSEN 功能及放射学评分和并发症发生情况。 结果 观察组患者切口长度明显优于对照组患者，差异有统计学意义（P<0.05），观察组患者手术时间、住院时间明显短于对照组患者，差异有统计学意义（P<0.05），观察组患者骨愈合时间和切口愈合时间显著短于对照组患者，差异有统计学意义（P<0.05）；两组患者比较RASMUSSEN 放射学评分和功能评分，观察组患者优良率均明显高于对照组患者，差异有统计学意义（P<0.05）；术后两组患者比较近、远期并发症发生率情况，观察组患者明显少于对照组患者，差异有统计学意义（P<0.05）。 结论 后外侧胫骨平台骨折使用关节镜辅助下内固定治疗具有手术时间短、切口创伤小，并发症发生率低，住院时间和愈合时间明显缩短等优点，且膝关节功能恢复和复位效果均满足患者要求，因此用其治疗后外侧胫骨平台骨折值得临床推廣使用。

[关键词] 后外侧胫骨平台骨折；关节镜；切口愈合时间；内固定

[中图分类号] R687.3 [文献标识码] A [文章编号] 2095-0616（2017）12-165-04

Comparison of internal fixation and conventional open reduction for posterolateral tibial plateau fractures assisted by knee arthroscopy

FU Shengpei

Yu'nan Country People's Hospital， Yu'nan 527199， China

[Abstract] Objective To study the curative effect of internal fixation and conventional open reduction for posterolateral tibial plateau fractures assisted by knee arthroscopy. Methods 85 patients with lateral tibial plateau fracture hospitalized in our hospital from January 2013 to June 2015 were selected. According to the method of voluntary choice， they were divided into two groups with 41 cases in control group and 44 cases in observation group. Patients in observation group were treated with arthroscopic assisted internal fixation for knee joint， and patients in control group were treated with traditional incision treatment. General characteristics （time of operation， length of stay， length of incision， time of incision and healing of bone） of the two groups were observed. RASMUSSEN function and radiological score and complications of the two groups were compared. Results The length of incision in the observation group was obviously better than that in the control group， the difference was statistically significant （P<0.05）. The operation time and length of stay in the observation group were significantly shorter than those in the control group， the difference was statistically significant （P<0.05）. The bone healing time and wound healing time in the observation group were significantly shorter than those in the control group， the difference was statistically significant （P<0.05）. The RASMUSSEN radiology score and functional score were compared between the two groups， and the excellent and good rate of the observation group was higher than that of the control group， the difference was statistically significant （P<0.05）. The postoperative complications of the two groups were significantly lower than those of the control group （P<0.05）. Conclusion The treatment of posterolateral tibial plateau fracture with arthroscopy assisted internal fixation has the advantages of short operation time， small incision trauma， low complication rate， shorter hospitalization time and shorter healing time. And the knee joint function restoration and the reduction effect meet the patient's request. Therefore， the treatment of posterolateral tibial plateau fractures is worthy of clinical use.

[Key words] Posterolateral tibial plateau fracture； Arthroscopy； Incision healing time； Internal fixation

胫骨平台骨折是一种较为常见的关节内骨折，其主要导致原因约有50%为道路交通事故伤造成。其发生的原因多种多样，临床症状表现不固定，如果患病后不能及时得到治疗，将会严重影响患者的治疗效果[1-2]。经检查确诊为胫骨平台骨折都需要手术对出现关节面塌陷或移位进行治疗才能恢复关节面的平整，使关节骨折块稳定和复位。针对胫骨平台骨折的主要治疗方法为，传统切开手术治疗和膝关节镜辅助下内固定治疗方法。在传统切开手术治疗视下的复位内固定，由于视野范围的限制，不仅手术创伤刀口大，而且患者复位和治疗效果不理想[3]。随着微创外科治疗技术在临床上的不断发展，胫骨平台骨折使用关节镜辅助下内固定治疗已成为一种新的治疗途径，因其治疗骨折具有刀口小、出血少、并发症少，恢复快等优点。……