摘要
目的探讨关节镜下经皮复位、空心钉内固定治疗胫骨平台骨折的手术方法及疗效。方法2004年5月-2008年4月,收治27例胫骨平台骨折患者。男19例,女8例;年龄18～61岁,平均41.5岁。致伤原因:交通事故伤18例,高处坠落伤6例,重物砸伤2例,其他伤1例。骨折按Schatzker分型:Ⅰ型8例,Ⅱ型12例,Ⅲ型2例,Ⅳ型5例。受伤至手术时间为3～15d,平均5.2d。关节镜下对11例半月板损伤、4例内侧副韧带损伤、3例前交叉韧带断裂及2例软骨骨折后形成关节内游离体对症处理后,经皮复位骨折,采用2～4枚直径7.0mm空心钉固定骨折。6例骨缺损明显者行自体髂骨植骨修复。术后早期功能锻炼。结果手术时间55～150min,平均93min;住院时间7～22d,平均16d。术后切口Ⅰ期愈合。术后均出现患侧小腿水肿,经对症处理后3d内消失。1例因不配合功能锻炼,关节粘连,术后1个月麻醉下予手法按摩松解,术后3个月功能接近正常。患者均获随访,随访时间6～36个月,平均16.6个月。膝关节活动度为105～140°,平均121°;无关节不稳发生。术后6个月,按照Lysholm膝关节功能评分标准,膝关节功能评分72～100分,平均93.6分。术后6个月X线片检查示患者关节面残留台阶<2mm,无骨性关节炎发生;1例出现外侧平台再塌陷,不影响正常工作,未作特殊处理。结论关节镜下经皮复位、空心钉内固定具有损伤小、恢复快、功能恢复满意等优点,是治疗低能量胫骨平台骨折的有效方法之一。
Objective To explore the treatment of low-energy tibial plateau fractures with arthroscopic percutaneous osteosynthesis. Methods From May 2004 to April 2008, 27 cases of tibial plateau fractures were treated with arthroscopic management. There were 19 males and 8 females, aged 18-61 years old （mean 41.5 years old）. Fracture was caused by traffic accident in 18 cases, by falling from height in 6 cases, by bruise in 2 cases, and by other in 1 case. There were 8 cases of type Ⅰ, 12 cases of type Ⅱ, 2 cases of type Ⅲand 5 cases of type Ⅳ according to Schatzker classification. The time from injury to operation was 3-15 days （mean 5.2 days）. After symptomatic managements were performed arthroscopically in 11 cases of meniscus tear, 4 cases of medial collateral ligament rupture of knee joint, 3 cases of anterior cruciate ligament rupture of knee joint and 2 cases of cartilage fracture resulting in joint bodies, fracture was reduced and fixed with 2 or 4 cannulated screws （7 mm in diameter）. Autograft of ilium was given 6 cases of bone defect. Early functional exercise was done. Results The operation time was 55-150 minutes （mean 93 minutes）; the hospitalization days were 7-22 days （mean 16 days）. All incision healed primarily. Edema of the affected leg occurred in all patients and subsided after 3 days of symptomatic management. In one patient who did not cooperate in functional exercise, adhesion occurred and normal function was recovered after by manual dissolution under conditions of anesthesia after 3 months of operation. All patients were followed up 6-36 months （mean 16.6 months）. The range of motion of knee joint was 105-140° （mean 121°）. According to Lysholm scale of knee joint, the score was 72-100 points （mean 93.6 points） 6 months after operation. The X-ray film showed no signs of osteoarthritis. Conclusion Arthroscopic percutaneous osteosynthesis yields satisfactory results and can be accepted as an alternative and effective method for the treatment of low-energy tibial plateau fractures.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2009年第11期1316-1318,共3页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
胫骨平台骨折
关节镜
空心钉
内固定
Tibial plateau fracture Arthroscope Cannulated screw Internal fixation
