关节镜下辅助治疗胫骨平台骨折38例

目的探讨关节镜在微创治疗胫骨平台骨折术中应用的方法及意义。方法应用关节镜辅助下治疗有手术指征的胫骨平台骨折患者38例,按Schatzker分类法：Ⅰ型10例、Ⅱ型12例、Ⅲ型8例、Ⅳ型3例、Ⅴ型3例、Ⅵ型2例,按照骨折的不同类型和损伤程度,采用关节镜监视下有限切开复位,可吸收螺钉、空心螺钉或钢板内固定,关节镜下处理半月板损伤,合并交叉韧带损伤病人,二期修复前后交叉韧带。术后3天开始功能锻炼,术后6周支具保护下负重训练。结果 38例应用关节镜技术治疗的患者全部得到随访,随访8~52个月,平均15.5个月。根据Rasmussen膝关节功能评分标准（总分30分,膝关节活动功能0~6分）1],35例优良;2例SchatzkerⅤ型、1例Ⅵ型患者术后出现活动受限,总体效果满意。骨折愈合时间快,功能恢复时间早、恢复好。结论关节镜下辅助治疗胫骨平台骨折可同时处理关节内合并伤、具有手术创伤小,并发症少、疗效肯定等优点。

Treatment of tibial plateau fractures of 38 cases under the arthroscopy.

Objective To observe the application of arthroscopy in the minimally invasive treatment of tibial fractures.Methods We analyzed 38 cases who received the small incision operation for tibial plateau fractures under the arthroscopy.According to the classification of Schatzker,10 cases were fallen into typeⅠ,12 into type Ⅱ,8 into type Ⅲ,3 into type Ⅳ andⅤ respectively,and 2 into type Ⅵ.The fracture was subjected to reduction and fixed under the arthrospy,by applying diverse inner fixation screws,or plates.The injured meniscus was treated by arthrospy.If the anterior or posterior ligaments were ruptured,they were rebuilt by two-stage.All the patients started function exercises 3 days after operation,and ambulated after 6 months with the help of brackets.Results All the patients were followed-up from 8 to 52 months（mean 15.5 months）.According to the Rasmussen Standard for knee function,the effectiveness in 35 cases was excellent.Knee joint stiffness was found in 2 cases of Schatzker type Ⅴ fractures,and the effectiveness in one case was unsatisfied because of the bad function of extension and flexion.Patients treated with the help of arthroscophy got shorter recovery time and better joint functions.Conclusion Treatment of tibial fractures under the arthroscopy has the advantages of minimal invasion,less complications and shorter recovery time.The more important is that meniscus injury should be treated at same time.