关节镜辅助下手术治疗胫骨平台骨折

目的 探讨关节镜辅助下手术治疗Schatzker Ⅰ～Ⅳ型胫骨平台骨折的疗效.方法 回顾性分析2002年10月至2009年10月关节镜辅助下手术治疗且获得随访的26例胫骨平台骨折患者资料,男15例,女11例;年龄24～68岁,平均43.6岁.骨折按Schatzker分型:Ⅰ型3例,Ⅱ型8例,Ⅲ型9例,Ⅳ型6例.关节镜辅助下采用撬拨和推顶的方法使胫骨平台骨折复位,骨缺损处用自体骨或同种异体骨植骨并采用拉力螺钉或支撑钢板固定.结果 本组26例患者平均手术时间为92.6 min(60～120 min),骨折复位满意率为100%,术后创伤反应轻,无局部感染,切口愈合良好,无血管、神经损伤等严重并发症发生.26例患者术后获10～24个月(平均14.6个月)随访.26例患者骨折均获愈合,愈合时间为12～24周,平均16周.按Rasmussen膝关节功能分级系统评定疗效:优16例,良9例,中1例,优良率为96.2%.结论 关节镜辅助下手术治疗Schatzker Ⅰ～Ⅳ型胫骨平台骨折具有创伤小、骨折复位满意、术后反应轻、骨折愈合良好及功能恢复快等优点.

Arthroscopically assisted surgery for tibial plateau fractures

Objective To report outcomes of arthroscopically assisted surgery for tibial plateau fractures of Schatzker types Ⅰ-Ⅳ. Methods From October 2002 to October 2009, 26 patients with tibial plateau fracture were treated with arthroscopically assisted surgery at our department.They were 15 males and 11 females, aged from 24 to 68 years (average, 43.6 years).Accordingto Schatzker classification, 3 cases were of type Ⅰ, 8 of type Ⅱ, 9 of type Ⅲ and 6 of type Ⅳ.Fracture segments of the tibial plateau were reduced under arthroscopy, and bone defects were filled with autografts or allografts before fixation with compression lag screws or buttress plates.Results The mean operation time was 92.6 minutes (from 60 to 120 minutes) .The satisfactory reduction rate was 100%.Postoperative traumatic reactions were slight,without local infection.Incisions healed well, without serious vascular or neural complications.All the 26 patients were followed up for an average of 14.6 months (from 10 to 24 months).All the fractures healed well after 12 to 24 weeks (average, 16 weeks).According to the Rasmussen scoring for knee function, 16 cases were excellent, 9 good and one was fair, with an excellent-to-good rate of 96.2%.Conclusion In treatment of tibial plateau fractures of Schatzker types Ⅰ-Ⅳ, arthroscopically assisted surgery has advantages of satisfactory reduction, limited operative invasion, mild postoperative reaction, fine bone healing and fast functional recovery.