胫骨平台骨折关节镜下复位内固定

Arthroscopic reduction and internal fixation for treatment of tibial plateau fractures

摘要:

［目的］探讨前外侧入路膝关节镜下复位内固定（arthroscopic reduction and internal fixation, ARIF）治疗胫骨平台骨折的效果。［方法］回顾性分析 2018 年 1 月—2020 年 1 月，手术治疗的胫骨平台骨折 95 例患者的临床资料。其中，49 例采用前外侧入路 ARIF 治疗，46 例常规切开复位内固定术 （open reduction and internal fixation, ORIF）。比较两组围手术期情况，随访结果和影像资料。［结果］两组均顺利完成手术，无重要血管、神经、半月板等医源性损伤。ARIF 组切口长度、手术时间、术中出血量、透视次数、术后引流量、术后下地时间、住院时间和术后 3 d VAS 评分均显著优于 ORIF 组（P<0.05）。两组患者术后均获随访 12~24 个月，平均 （16.5±3.6） 个月。不良事件，ARIF 组为 1/49 （2.0%），ORIF 组 8/46 （17.4%），差异有统计学意义 （P<0.05）。ARIF 组术后完全负重时间显著早于 ORIF 组 （P<0.05）。术后 3 个月及末次随访时，ARIF 组的 HSS 评分、 Lysholm 评分、Rasmussen 功能评分均显著高于 ORIF 组，膝关节活动最大屈曲及过伸 ROM 均显著高于 ORIF 组，差异均有统计学意义（P<0.05）。影像学方面，术后即刻及末次随访时 ARIF 组的 Rasmussen 解剖评分均显著高于 ORIF 组（P<0.05）。与术前相比，术后即刻及末次随访时两组的关节面塌陷均显著降低（P<0.05）；但是术后即刻与未次随访时，ARIF 组的关节面塌陷显著小于 ORIF 组（P<0.05）。［结论］膝关节镜下复位内固定胫骨平台骨折的临床效果明显优于开放复位内固定。

Abstract:

[Objective] To explore the clinical outcomes arthroscopic reduction and internal fixation (ARIF) through the anterolateral approach for treatment of tibial plateau fractures. [Methods] A retrospective study was done on 95 patients who underwent surgical treat- ment for tibial plateau fractures from January 2018 to January 2020 in our hospital. Among them, 49 patients receive ARIF through antero- lateral approach, while the remaining 46 patients were treated with conventional open reduction and internal fixation (ORIF) according to the consequence of preoperative patient-doctor communication. The perioperative conditions, follow-up results and imaging data were com- pared between the two groups. [Results] All patients in both groups were successfully operated on without iatrogenic injuries to important blood vessels, nerves and meniscus. The ARIF group proved significantly superior to the ORIF group in terms of incision length, operative time, intraoperative blood loss, frequency of fluoroscopy, postoperative drainage, time to return ambulation with crutches, hospital stay and VAS score 3 days postoperatively (P＜0.05) . All patients in both groups were followed up for 12~24 months, with an average of (16.5±3.6) months. Adverse events were 1/49 (2.0%) in the ARIF group, whereas 8/46 (17.4%) in the ORIF group, which was statistically significant (P＜0.05) . The ARIF group resumed full weight-bearing activity significantly earlier than the ORIF group (P＜0.05) . In addition, the ARIF group was significantly superior to the ORIF group in terms of HSS, Lysholm and Rasmussen function scores, as well as knee flexion and ex- tension range of motions (ROMs) at 3 months and the latest follow-up (P＜0.05) . Regarding to radiographic evaluation, the ARIF group had significantly higher Rasmussen anatomical scores than the ORIF group immediately after surgery and at the latest follow-up (P＜0.05) . The articular surface collapse was significantly reduced in both groups immediately after surgery and at the last follow-up compared with those before operation (P＜0.05) , whereas which in the ARIF group were significantly less than those in the ORIF group immediately after surgery and at the latest follow-up (P＜0.05) . [Conclusion] The arthroscopic reduction and internal fixation is considerably superior to the conven- tional open reduction and internal fixation in term of clinical outcomes for tibial plateau fractures