关节镜辅助复位内固定治疗SchatzkerⅤ~Ⅵ型胫骨平台骨折疗效分析

【摘要】 目的 探究关节镜辅助复位内固定治疗 Schatzker Ⅴ~Ⅵ型胫骨平台骨折的临床疗效。方法 选取2018 年 3 月至 2020 年 10 月正阳县人民医院收治的 116 例 Schatzker Ⅴ~Ⅵ型胫骨平台骨折患者作为研究对象, 按照随机数表法将其随机分为观察组 (58 例) 和对照组 (58 例), 观察组患者采用关节镜辅助复位内固定治疗,对照组患者采用常规切开复位内固定治疗, 对比观察两组患者术中出血量、手术时间、住院时间、骨折愈合时间等手术相关指标以及膝关节恢复情况与并发症发生情况。 结果 观察组患者术中出血量明显少于对照组 ( t =25.756, P<0.001), 手术时间、住院时间及骨折愈合时间均明显短于对照组 ( t = 2.924、8.643、4.802, P =0.004、P<0.001、P<0.001); 术后随访1年, 观察组患者术后膝关节运动功能恢复情况与对照组无明显差异(Z= -1.721, P= 0.085); 术后 6 个月及术后 1 年, 观察组患者膝关节最大活动度明显大于对照组 ( t = 12.547、16.387, P 均<0.001), 美国特种外科医院 (HSS) 评分与 Rasmussen 评分均明显高于对照组 (术后6个月: t =8.444、8.783, P 均<0.001; 术后 1 年: t = 9.002、9.358, P 均<0.001); 术后随访1年, 观察组患者术后并发症发生率为 12.07%, 明显低于对照组患者的术后并发症发生率27.59% ( χ2 = 4.393, P = 0.036)。 结论 与常规切开复位内固定相比, 关节镜辅助复位内固定治疗 SchatzkerⅤ~Ⅵ型胫骨平台骨折, 创伤更小, 骨折愈合时间更短, 更有利于术后膝关节功能及解剖结构的恢复。

Clinical Efficacy of Arthroscopy-assisted Reduction and Internal Fixation for Schatzker Type Ⅴ-Ⅵ Tibial Plateau Fractures

【Abstract】 Objective To study the clinical efficacy of arthroscopy-assisted reduction and internal fixation in treating Schatzker type Ⅴ-Ⅵ tibial plateau fractures. Methods 116 patients with Schatzker type Ⅴ-Ⅵ tibial plateau fractures, admitted to Zhengyang County People’s Hospital between March 2018 and October 2020, were enrolled as research subjects, and divided, using the random number table, into study group (n = 58) and control group ( n = 58). Patients in the study group received arthroscopy-assisted reduction and internal fixation, whereas patients in the control group underwent conventional open reduction and internal fixation. Surgery-related indicators, such as intraoperative blood loss volume, operation time, length of stay, fracture healing time, knee joint recovery, and occurrence of complications were compared between the two groups. Results In the study group, the intraoperative blood loss volume of patients was significantly lowerthan that in the control group (t = 25.756, P<0.001). Additionally, the study group exhibited significantly shorter operation time, length of stay, and fracture healing time compared with the control group (t = 2.924, 8.643 and 4.802, P= 0.004,P<0.001, P< 0.001). During the one-year follow-up after surgery, no significant difference was observed in knee joint function recovery between the two groups (Z = -1.721, P = 0.085). However, at six months and one year after surgery, patients in the study group demonstrated a notably larger maximum range of motion of the knee joint in comparison to those in the control group (t = 12.547 and 16.387, both P<0.001). Moreover, the Hospital for Special Surgery (HSS) score and Rasmussen score of patients were markedly higher in the study group (six months after surgery: t = 8.444 and 8.783, both P<0.001; one year after surgery: t = 9.002 and 9.358, both P< 0.001). The complication rate of patients during the one-year follow-up after surgery was 12.07% in the study group, being significantly lower than the corresponding 27.59% in the control group (χ2 = 4.393, P= 0.036). Conclusion Compared with conventional open reduction and internal fixation, arthroscopy-assisted reduction and internal fixation for Schatzker type Ⅴ-Ⅵ tibial plateau fractures, being less invasive, can realize faster fracture healing, and is more favorable for the postoperative recovery of knee joint functions and its anatomical structure.