关节腔造影对微创治疗胫骨平台骨折的辅助复位意义

目的探讨关节腔造影技术在微创治疗胫骨平台骨折术中对骨折复位的指导意义。方法回顾性分析2019年1月至5月间西安交通大学附属红会医院创伤骨科医院下肢病区收治的9例胫骨平台骨折患者资料。男6例,女3例;年龄27~63岁,平均45.5岁;骨折根据Schatzker分型:Ⅱ型6例,Ⅲ型1例,Ⅳ型2例。术中所有患者均在关节腔内注入造影剂后透视寻找造影剂填充最低点;骨折复位植骨后再次造影透视,关节面复位满意后经皮微创置入接骨板。术前和术后6个月测量并比较膝关节活动度及美国特种外科医院(HSS)膝关节功能评分;术后6个月根据Rasmussen影像学评价标准对膝关节X线片进行评分,同时记录手术前后关节面塌陷程度及术后并发症发生情况。结果所有患者术后获3~10个月(平均7个月)随访。所有患者均于术后12周内达骨性愈合。术前膝关节屈曲60.7°±13.1°,伸直4.6°±2.9°,HSS评分为(51.9±5.7)分;术后6个月膝关节屈曲122.4°±10.8°,伸直4.4°±2.5°,HSS关节评分为(84.9±5.3)分。术前与术后6个月膝关节屈曲活动度和HSS评分比较差异均有统计学意义(P<0.05),但伸直活动度比较差异无统计学意义(P>0.05)。关节面塌陷程度由术前9.5 mm(5~15 mm)恢复至术后1.3 mm(0~3 mm)。术后6个月Rasmussen影像学评分:优6例,良3例。术后未出现切口感染、关节僵硬、内固定物松动及断裂等并发症。结论胫骨平台骨折术中通过关节腔造影可较好地观察骨折塌陷的情况,同时准确判断关节面间接复位的情况,有益于微创治疗胫骨平台骨折的疗效。

Arthrography-assisted reduction in minimally invasive treatment of tibial plateau fractures

Objective To evaluate arthrography-assisted reduction in minimally invasive treatment of tibial plateau fractures.Methods From January to May 2019,9 patients with tibial plateau fracture were treated by arthrography-assisted minimally invasive surgery at Department of Orthopaedics and Traumatology,Hong-Hui Hospital.They were 6 males and 3 females with an average age of 45.5 years(from 27 to 63 years).According to the Schatzker classification,there were 6 cases of typeⅡ,one of typeⅢand 2 cases of typeⅣ.Arthrography was used to determine the lowest filling point of contrast medium after intra-articular injection and to ensure satisfactory reduction of articular surface after fracture reduction and bone grafting,followed by minimally invasive percutaneous plate implantation.Comparisons were made between preoperation and 6 months postoperation in the range of knee motion and knee scores of The Hospital for Special Surgery(HSS).Knee X-ray films were evaluated by the Rasmussen imaging system at 6 months postoperation.Collapse of articular surface was recorded pre-and post-operation as well as postoperative complications.Results All the 9 patients were followed up for 6 to 9 months(average,7 months).All patients achieved bony union within 12 weeks postoperation.The preoperative knee flexion(60.7°±13.1°)and HSS(51.9±5.7)were significantly improved to 122.4°±10.8°and 84.9±5.3 at 6 months postoperation(P<0.05),but there was no significant difference between preoperation and 6 months postoperation in knee extension(4.4°±2.5°versus 4.6°±2.9°)(P>0.05).The collapse of articular surface was improved from preoperative 9.5 mm(from 5 to 15 mm)to postoperative 1.3 mm(from 0 to 3 mm).The Rasmussen imaging scores at 6 months postoperation showed 6 excellent and 3 good.No such postoperative complications occurred as incision infection,joint stiffness,loosening or breakage of implants.Conclusion Arthrography helps minimally invasive treatment of tibial plateau fracture because it can better display fracture collapse during operation and accurately judge indirect reduction of articular surface.