关节镜辅助下胫骨平台重度粉碎性骨折的固定与重建

目的 探讨胫骨平台重度粉碎性骨折的临床特点及关节镜辅助下进行复位固定的疗效.方法 2007年6月至2010年5月共收治12例胫骨平台重度粉碎性骨折患者,男10例,女2例；年龄19 ～53岁,平均33.8岁.骨折按Schatzker分型:V型4例,Ⅵ型8例.受伤至手术时间为2～15d(平均4.3d).术中先在关节镜下探查膝关节腔内韧带及半月板损伤情况；然后复位胫骨平台干骺端骨折,并在关节镜直视下行胫骨平台关节面塌陷性骨折的顶起复位与充填植骨；最后根据胫骨干骺端骨折部位及复位情况采用侧方钢板固定.结果 12例患者术后获12 ～42个月(平均26个月)随访.12例患者骨折复位情况按Rasmussen胫骨平台骨折影像学评分系统评定:评分为10～17分,平均15.6分；其中优10例,良2例.12例患者骨折均获骨性愈合,骨折愈合时间为3.0～4.5个月(平均3.5个月).术后6个月膝关节功能采用Rasmussen评分系统评定:评分为18 ～28分,平均25.8分；其中优3例,良8例,可1例.随访期间无内固定失效、膝内、外翻畸形及深部感染等并发症发生.结论 关节镜辅助下治疗胫骨平台重度粉碎性骨折具有手术创伤小、恢复快及并发症少等优点.关节镜直视下胫骨平台塌陷关节面的复位与重建是一种安全、可行的微创治疗手段.

Arthroscopically assisted reduction and reconstruction of severe comminuted tibial plateau fractures

Objective To investigate clinical characteristics and outcomes of arthroscopically assisted reduction and reconstruction of severe comminuted tibial plateau fractures.Methods From June 2007 to May 2010,12 patients with severe comminuted tibial plateau fracture were treated with arthroscopy-assisted surgery at our department.They were 10 males and 2 females,aged from 19 to 53 years (average,33.8 years).According to Schatzker classification,4 cases were of type V and 8 of type Ⅵ.The time from injury to operation was 2 to 15 days(average,4.3 days).The fracture was combined with meniscus injury in 8 cases,anterior cruciate ligament injury in 5 cases,and medial collateral ligament injury in 5 cases.First,arthroscopic inspection of the joint structures was performed,followed by reduction of tibial plateau fracture.Then,bone grafting was conducted in the area of bone defect,and internal fixation using strut plates was performed after establishing subcutaneous tunnel via minimally invasion.Results Over the follow-up period of 12 to 42 months(average,26 months),there was no failure of internal fixation,traumatic knee osteoarthritis,or deformity of the knee.By the radiological Rasmussen criteria,the 12 patients scored 10 to 17 points,averaging 15.6 points; 10 were rated as excellent and 2 as good.The fractures healed within 3.0 to 4.5 months(average,3.5 months).By the functional Rasnussen criteria for the knee,the 12 patients scored 18 to 28 points 6 months after operation,averaging 25.8 points; 3 were rated as excellent,8 as good and one as fair.Conclusions Arthroscopy-assisted surgery has advantages of satisfactory reduction,limited invasion and fewer conplications in treatment of severe comminuted tibial plateau fracture.Reduction of the collapsed tibial plateau can be safely and efficiently performed under direct arthroscopic visualization.