周宏斌　屈万明

[摘要] 目的 比较关节镜辅助下自制定位、复位器械微创固定和开放复位内固定治疗SchatzkerⅡ、Ⅲ型胫骨平台骨折的效果。 方法 选取2008年5月～2013年12月宜昌市夷陵医院（以下简称“我院”）收治64例SchatzkerⅡ、Ⅲ型胫骨平台骨折患者，定位及复位器械由我院课题组自行研发，根据治疗方法的不同将患者分为两组，关节镜组32例采用关节镜辅助下自制定位、复位器械微创固定治疗，对照组32例采用切开复位内固定治疗。比较两组手术时间、切口长度、骨折愈合时间、术后并发症发生情况；按美国特种外科医院（HSS）膝关节评分标准行膝关节功能评分。 结果 关节镜组手术时间[（119.44±14.19）min]较对照组[（90.78±13.71）min]长，切口长度[（3.05±1.73）cm]较对照组[（13.84±1.90）cm]短，差异均有高度统计学意义（P < 0.01）。术后6个月关节镜组膝关节HSS评分[（88.25±5.21）分]优于对照组[（80.47±9.08）分]，差异有高度统计学意义（P < 0.01）。X线片检查示两组骨折均达骨性愈合，关节镜组骨折愈合时间[（100.16±7.57）d]较对照组[（103.88±6.71）d]短，差异有统计学意义（P < 0.05）。 结论 关节镜辅助下自制定位、复位器械微创内固定治疗SchatzkerⅡ、Ⅲ型胫骨平台骨折与切开复位内固定相比，具有创伤小、术后愈合及功能恢复快、并发症少等优点。

[关键词] 胫骨平台骨折；关节镜；微创；内固定

[中图分类号] R683 [文献标识码] A [文章编号] 1673-7210（2015）05（c）-0092-05

[Abstract] Objective To compare the effect of minimally invasive fixation of homemade positioning， restoration instruments assisted by arthroscopic and open reduction and internal fixation for Schatzker types Ⅱ and Ⅲ tibial plateau fractures. Methods Sixty four cases of patients with Schatzker tppe Ⅱ， Ⅲ tibial plateau fracture admitted to Yichang Yiling Hospital （“our hospital” for short） from May 2008 to December 2013 were chosen， the positioning and restoration instruments were researched by research group of our hospital. The patients were divided into two groups according to different treating methods. 32 cases of arthroscopic group were taken the treatment of minimally invasive fixation of homemade positioning， restoration instruments assisted by arthroscopic， 32 cases of control group were given open reduction and internal fixation. The conditions of operation time， incision length， fracture healing time， and complications between two groups were compared. The knee function scores were measured according to American Hospital for Special Surgery （HSS） score standard. Results The operation time [（119.44±14.19） min] of arthroscopic group was longer than that of control group [（90.78±13.71） min]， the incision length [（3.05±1.73） cm] was shorter than that of control group [（13.84±1.90） cm]， the differences were highly statistically significant （P < 0.01）. The HSS score of 6 months after surgery of arthroscopic group [（88.25±5.21） points] were significantly greater than those of control group [（80.47±9.08） points]， the difference was highly statistically significant （P < 0.01）. The X-ray films showed that all the fractures in the two groups reached to bony union. The fracture healing time of arthroscopic group [（100.16±7.57） d] was shorter than that of control group [（103.88±6.71） d]， the difference was statistically significant （P < 0.05）. Conclusion Compared with open reduction and internal fixation， the minimally invasive fixation of homemade positioning， restoration instruments assisted by arthroscopic for Schatzker types Ⅱ and Ⅲ tibial plateau fractures has such advantages as minimal trauma， fast postoperative healing and functional recovery， and less complications.

[Key words] Tibial plateau fracture； Arthroscopic； Minimally invasive； Internal fixation

胫骨平台骨折（fracture of tibial plateau，FTP）常由高处坠落等高能量损伤撞击平台所致[1]，属关内骨折，可有不同程度的关节面压缩和移位。常伴有膝关节软骨、内外侧副韧带、前后交叉韧带及半月板等结构损伤，如未获有效治疗，将影响膝关节的对合、稳定与运动[2-4]。1985年Jennings[5]首次将关节镜技术与FTP的手术治疗相结合，实现了从传统切开手术到微创手术的变革，但是关节镜下如何达到塌陷骨块的精确复位固定仍然有待于学者们进一步探索。选取湖北省宜昌市夷陵医院2008年5月～2013年12月收治的FTP患者中符合SchatzkerⅡ、Ⅲ型分类的患者共64例，分别采用关节镜辅助下自制定位器精确制导空心钉固定和切开复位内固定治疗，分析两组患者的治疗相关数据并比较两种术式的疗效。……