有限切开间接复位治疗简单胫骨平台骨折:应用C型臂X线机透视与关节镜监视两种方法的比较

目的探讨应用C型臂X线机透视和应用关节镜监视对简单胫骨平台骨折有限切开间接复位治疗的效果比较。方法采用有限切开间接复位技术治疗58例简单胫骨平台骨折,其中31例在C型臂X线机透视下完成(C型臂组),27例在关节镜监视下完成(关节镜组)。比较两种治疗方法在手术时间、软组织合并伤、术后早期并发症、内固定失败、膝关节功能(Hohl和Lcuk膝关节评分)等指标的差异。结果两组患者手术时间比较,差异有统计学意义(P<0.05)。两组患者术后早期并发症、内固定失败、膝关节功能评分等指标比较,差异无统计学意义(P>0.05)。结论对简单胫骨平台骨折行有限切开间接复位固定在应用C型臂X线机透视和应用关节镜监视指导下均能取得良好的治疗效果。C型臂X线机透视指导下复位结合有限切开间接复位内固定技术仍是治疗简单胫骨平台骨折的主要治疗手段,特别适合在不具备关节镜设备的县级以下基层医院开展。应用关节镜指导操作较应用C型臂X线机透视指导操作要相对复杂,手术时间长,需要专门训练。

Limited exposure and indirect reduction in simple tibial plateau fractures: Fluoroscopic versus arthroscopic control of reduction

Objective To investigate the therapeutic effect of limited exposure and indirect reduction in simple tibial plateau fractures: fluoroscopic versus arthroscopic control of reduction.Methods Fifty-eight patients with monocondylar fractures of the lateral plateau were treated by limited exposure and indirect reduction techniques.Thirty-one cases were treated by reduction and fixation solely under fluoroscopic control,while the other twenty-seven cases underwent arthroscopic control of reduction.The differences of the time of operation,the complications of soft tissue,the early complications after operation and the cases of failure of fixation,ROM of the knee joints,knee joint’s function(the Hohl and Luck knee joints scores) were compared.Results There were significant differences between the two groups in the mean operation time(P <0.05).There were no significant differences between the two groups in the early complications after operation and the cases of failure of fixation and knee joint’s function(The Hohl and Luck knee joints scores)(P >0.05).Conclusion Limited exposure and indirect reduction techniques for treatment of fractures of the lateral tibial plateau can be performed using arthroscopy as well as image intensification to control reduction of the joint surface for fractures of the lateral tibial plateau.The limited exposure and indirect reduction techniques under fluoroscopic control solely is still a main treatment method for simple tibial plateau fractures,particularly suitable for primary hospital without the arthroscopy equipment.Reduction under arthroscopy is technically more complicated in our practice,needing professional training.