关节镜辅助下治疗胫骨平台骨折.docVIP

关节镜辅助下治疗胫骨平台骨折【摘要】目的：探讨关节镜下治疗胫骨平台骨折的方法和疗效。方法：总结78例胫骨平台骨折患者的临床资料，SchatzkerⅠ型18例，Ⅱ型23例，Ⅲ12例，Ⅳ25例，均在关节镜下复位固定，同时镜下处理关节内合并损伤。结果：75例病例获得10～28个月随访，平均18.7个月。骨折在术后平均7.3个月达骨性愈合，无1例畸形愈合。按照HSS膝关节功能评定标准，其中优52例(69.3%)，良15例(20%)，中8例(10%)，优良率为89.3％。结论：关节镜辅助下治疗胫骨平台骨折具有创伤小，复位精确，功能恢复满意等优点。 【关键词】胫骨平台；骨折；关节镜；内固定 文章编号：1009-5519（2008）01-0021-02 中图分类号：R6 文献标识码：A Arthroscopic treatment for tibial plateau fractures ZHANG Chao-yue，TANG Guo-ke，WU Hong-wei （Department of Orthopedics，The Third Xiangya Hospital of Zhongnan University，Changsha 410013，China） 【Abstract】Objective：To discuss the treatment of tibial plateau fractures under arthroscope and the recent clinical outcome.Methods：Seventy-eight cases with tibial plateau fractures in which eighteen cases were typeⅠfracture，twenty-three cases were type Ⅱ，twelve cases were type Ⅲ and twenty-five cases were type Ⅳ based on Schatzker criteria were all treated by arthroscopic fixation.During operation，the combined injures were treated firstly.Then，the dislocative fragments were managed with anatomic reduction and fixated.Results：There were seventy-five cases followed up for 10～28 months(mean 18.7 months).All the fractures were healed within 7.3 months，with no malunion.According to the American HSS Score for knee，52 cases got excellent(69.3%)，15 good(20%) and 8 fair(10%)，and the rate ofexcellent and good was 89.3%.Conclusion：Treatment of tibial plateau fractures under arthroscope is characterized by minimal invasion，exact reduction，sound knee joint function and worth further clinical application. 【Ｋey words】Tibialplateau；Fracture；Arthroscope；Internal fixation 胫骨平台骨折在临床上非常常见，约占各种骨折的4％。骨折累及到关节面，因为要求解剖复位，处理起来比较棘手，常导致创伤性关节炎、关节不稳和关节僵硬等并发症[1]。关节镜以其在放大的视野下复位骨折块、对关节内干扰小、功能恢复满意等优点，迅速为广大患者接受。我科于2003年7月~2007年5月，共用关节镜辅助下治疗胫骨平台骨折78例，获得满意疗效，报道如下。 1 临床资料 1．1 一般资料：本组78例，男56例，女22例，年龄25～67岁，平均41岁。车祸63例，高处坠落11例，压砸伤4例；左膝42例，右膝36例；Schatzker分型，Ⅰ型18例，Ⅱ型23例，Ⅲ12例，Ⅳ25例。其中合并半月板损伤7例，交叉韧带(包括前后交叉韧带)部分断裂5例，侧副韧带(包括内外侧副韧带)损伤3例。关节面塌陷6～15 mm，平均9 mm。手术时间为