两种手术方式治疗胫骨平台骨折的疗效比较

目的:比较关节镜联合经皮微创锁定钢板固定与切开复位钢板内固定方法治疗胫骨平台骨折的临床效果。方法:回顾性分析2007年1月～2011年3月收治的胫骨平台骨折54例。分为A组(26例)和B组(28例),分别采用切开复位钢板内固定和关节镜联合经皮微创锁定钢板固定方法治疗。比较两组关节功能优良率、手术时间、切口长度、住院时间、骨折愈合时间及并发症。结果:54例患者均获得随访,随访9个月至2年(平均15个月).切开复位钢板内固定组平均切口长度9.3cm,平均住院时间17.1d、平均骨折愈合时间16.7周,术后深部感染1例,局部皮肤坏死2例,关节僵硬2例,畸形愈合1例;关节镜联合经皮微创锁定钢板组平均切口长度4.22cm,平均住院时间12.5d、平均骨折愈合时间12.2周,术后均无深部感染、皮肤坏死、关节僵硬及创伤性关节炎发生。两组差异有统计学意义(P<0.05);A组平均手术时间2.58h,、B组平均手术时间2.23h,在手术时间方面差异无显著差异(P>0.05)。参照Rasmussen膝关节功能评分,术后1年A组与B组功能优良率分别为83.1%和92.5%,两组疗效差异有统计学意义。结论:关节镜联合经皮微创锁定钢板内固定治疗胫骨平台骨折手术创伤小、住院时间短、骨折愈合时间短、膝关节功能恢复较好。

Efficacy comparison of two methods for treatment of tibial plateau fractures

Objective: To compare the efficacy of minimally invasive arthroscopy combined with percutaneous locking plate fixation and pressure reduction and plate fixation for tibial plateau fractures.Methods:Retrospective study of 54 patients with tibial plateau fractures the admitted to our hospital during January 2007 to March 2011 was conducted.Group A(26 cases) underwent invasive arthroscopy combined with percutaneous locking plate fixation while group B(28 cases) underwent pressure reduction and plate fixation.Rate of excellent outcomes,operation time,incision length,hospital stay and bone recovery time as well as incidence of complications of the two groups were compared.Results:According to an average follow up of 15 months ranging from 9 months to 2 years.For group B,the average incision length was 9.3 cm,average hospital stay was 17.1 d,bone recovery time was 16.7 weeks;infection was observed in 1 case,topical skin necrosis in 2 cases,joint stiffness in 1 case,and malunion in one case.For group A,the average incision length was 4.22 cm,average hospital stay was 12.5 d,bone recovery time was 12.2 weeks;no infection,skin necrosis,joint stiffness or malunion occurred.There was no significant difference in the operation time between the two groups(P>0.05).According to the Rasmussen system,knee functions of 83.1%and 92.5% cases in group A and group B were evaluated as excellence,showing significant difference between the two groups.Conclusions:Invasive arthroscopy combined with percutaneous locking plate fixation is less minimal,it can help to decrease hospitalization time,union time,and is good for functional recovery of knee joint.