关节镜下微创锁定钢板固定与切开复位钢板内固定治疗胫骨平台骨折疗效比较

目的：比较关节镜下微创锁定钢板固定和传统切开复位钢板内固定治疗胫骨平台骨折（TPF）的疗效。方法选择2010年3月至2013年6月我院收治的TPF患者94例，按随机数字表分为对照组和观察组各47例。对照组行传统切开复位钢板内固定，观察组于关节镜下行微创锁定钢板固定（MIPPO），观察和比较两组的手术时间、术中出血量、住院时间、骨折愈合时间，采用Lysholm评分系统评价膝关节功能和SF-36评分量表评价生活质量评分及术后并发症等指标。结果观察组手术切口长度、术中出血量、住院时间、骨折愈合时间分别为（5.14±1.03） cm、（69.42±7.56） ml、（6.91±1.73） d和（10.22±1.38）周，均显著短于对照组（P〈0.05）；术后1年、2年和4年Lysholm功能评分分别为（91.26±11.78）分、（85.23±9.94）分和（81.59±8.63）分，均显著高于对照组（P〈0.05）；术后1年SF-36评分和VAS评分分别为（84.36±10.62）分和（8.21±0.70）分，显著高于对照组（P〈0.05）；总不良反应率为10.64%，显著低于对照组的23.40%（P〈0.05）。结论关节镜下微创锁定钢板固定治疗胫骨平台骨折具有创伤小、恢复快、术后关节优良率高、患者生活质量高等优点，疗效显著优于切开复位钢板内固定治疗。

Comparasion of the effect of arthroscopic minimally invasive locking plate fixation and open reductionfollowed by internal plate fixation on tibial plateau fractures.

Objective To compare the clinical effect of the arthroscopic minimally invasive locking plate fixation and open reduction followed by plate internal fixation on treatment of the tibia plateau fractures （TPF）. Methods Ninety four patients with TPF in our hospital from 2011 June to March 2013 were randomly selected and divided into the control group with 47 cases and the observation group with another 47 cases. The control group under-went conventional open reduction followed by plate fixation while the observation group was given minimally inva-sive percutaneous plate osteosynthesis （MIPPO）. The operation time, blood loss volumne, hospitalization time, and healing time of fracture were observed and recorded. Meanwhile, the Lysholm scoring system was applied to assess the knee joint function and SF-36 rating scale was used for estimating quality of life and postoperative complications. Results The operation incision length, blood loss volume, hospitalization time, and fracture healing time in the obser-vation group were （5.14±1.03） cm, （69.42±7.56） ml, （6.91±1.73） d and （10.22±1.38） w, which were significantly low-er than those in the control group （P〈0.05）. The Lysholm function score of 1 year, 2 years and 4 years after treatment were （91.26±11.78） points, （85.23±9.94） points and （81.59±8.63） points respectively, which were significantly higher than those in the control groups （P〈0.05）, while the SF-36 score and VAS score of 1 year after treatment were （84.36 ± 10.62） points and （8.21 ± 0.70） points respectively, which were significantly higher than those in the control group （P〈0.05）. The adverse reaction rate was 10.64%compared with 23.40%of the control group with significant difference （P〈0.05）. Conclusions The arthroscopic minimally invasive locking plate fixation with less trauma, quick recovery, higher excellent and good rate of postoperative joint function and higher life quality, showed better ef-fect on the tibia plateau fractures than open reduction followed by internal plate fixation.