关节镜辅助下治疗胫骨平台后外侧塌陷骨折

目的 探讨关节镜辅助下治疗胫骨平台后外侧塌陷骨折的可行性和临床疗效.方法 2006年3月至2007年9月,采用关节镜下复位,并经腓骨头进行螺钉横行固定,治疗胫骨平台后外侧塌陷骨折患者26例,男17例,女9例;年龄19~58岁,平均34.5岁.根据Schatzker分型:Ⅱ型21例,Ⅲ型5例.受伤机制:交通伤15例,建筑伤4例,运动伤7例.患者在平均伤后8d接受关节镜手术.观察手术时间、骨折愈合时间、完全负重时间、关节活动度、相关并发症的发生等,并进行HSS膝关节功能评分.结果 所有患者均获得随访,随访时间4~11个月,平均9个月.手术时间20~50min,平均35min;完全负重时间10~16周,平均11周;X线愈合时间9~17周,平均13.1周;关节活动度126°~155°,平均为135°.无一例发生感染、深静脉栓塞、骨筋膜间室综合征等并发症,亦未见横行螺钉松动、断裂.末次随访时HSS膝关节功能评分为84~98分,平均93分;优25例,良1例,优良率为100%.结论 胫骨平台后外侧塌陷骨折,借助关节镜治疗,创伤小,直视下精确复位,并跨腓骨头和内侧平台行软骨下螺钉固定,效果肯定,是非常有效的治疗方法.

Arthroscopically assisted treatment of the posterolateral depressed tibial plateau fracture

Objective To investigate the feasibility and clinical effect of the posterolateral depressed tibial plateau fracture by arthroscopically assisted treatment. Methods From March 2006 to September 2007, 26 patients with the posterolateral depressed tibial plateau fracture were reduced by arthroscopy and fixed laterigradely with lag screw through the capitulum fibulae. There were 17 males and 9females, and the patient age at surgery ranged from 19 to 58 years (mean, 34.5 years). According Schatzker classification, type Ⅱ for 21 patients, type Ⅲ for 5 patients. The injury mechanism included traffic injury for 15 cases, building injury for 4 cases, and sport injury for 7 cases. All patients were performed arthroscopy mean 8 days after injury. The operation time, bone union time, full weight-bearing time, range of motion, and related complications in all patients were observed, and HSS scores were used to evaluate the knee function. Results All patients got followed up. The follow-up periods ranged from 4 to 11 months (mean, 9 months). The mean operation time was 35 minutes (range, 20 to 50 minutes). The mean full weight-bearing time and radiographic bone union time were 11 and 13.1 weeks respectively, and the average ROM was 135°. None of the cases was found for infection, deep vein thrombosis, compartment syndrome, screw loosing and broken. The average HSS scores was 93 at the ultimated follow up (range, 84 to 98). There were 25 excellent cases, and 1 good case. The excellent and good rate was 100%. Conclusion Arthroscopically assisted treatment of the posterolateral depressed tibial plateau fracture was an very effective treatment methods, which showed less invasive and direct good reduction.