CAJ | 학술논문

目的比较研究关节镜下固定治疗胫骨髁间嵴骨折手术与切开手术的中远期疗效。方法对2003年2月至2011年9月分别行上述两种手术治疗的65例胫骨髁间嵴骨折进行回顾性分析。关节切开手术组32例，关节镜手术组33例。术前行X线拍片，术后3个月、6个月、12个月、36个月进行X线拍片和Lysholm关节评分。依据Meyers＆McKeever和Zaricznyj分型标准，65例骨折中，Ⅱ型20例，Ⅲ型29例，Ⅳ型16例。结果术后平均随访时间36个月（24～43个月）。两组患者复查X线片显示骨折愈合时间为术后6～12周，平均8周，均获得良好骨性愈合。 Lysholm评分在Ⅱ型、Ⅲ型骨折中关节镜组和传统手术组在3个月和6个月期间评分无统计学差异（ P＞0.05），而在术后随访的12个月和36个月期间，两组间差异有统计学意义（ P＜0.05）。但是，对于Ⅳ型骨折，两组均有膝前疼痛和伸膝活动障碍，Lysholm评分两组差异无统计学意义（ P＞0.05）。结论关节镜下固定胫骨髁间棘骨折远期疗效较传统手术优越，是一种简单、安全及有效的方法，但是，对于Ⅳ型骨折，两组均有膝前疼痛和伸膝活动障碍。
목적비교연구관절경하고정치료경골과간척골절수술여절개수술적중원기료효。방법대2003년2월지2011년9월분별행상술량충수술치료적65례경골과간척골절진행회고성분석。관절절개수술조32례，관절경수술조33례。술전행X선박편，술후3개월、6개월、12개월、36개월진행X선박편화Lysholm관절평분。의거Meyers＆McKeever화Zaricznyj분형표준，65례골절중，Ⅱ형20례，Ⅲ형29례，Ⅳ형16례。결과술후평균수방시간36개월（24～43개월）。량조환자복사X선편현시골절유합시간위술후6～12주，평균8주，균획득량호골성유합。 Lysholm평분재Ⅱ형、Ⅲ형골절중관절경조화전통수술조재3개월화6개월기간평분무통계학차이（ P＞0.05），이재술후수방적12개월화36개월기간，량조간차이유통계학의의（ P＜0.05）。단시，대우Ⅳ형골절，량조균유슬전동통화신슬활동장애，Lysholm평분량조차이무통계학의의（ P＞0.05）。결론관절경하고정경골과간극골절원기료효교전통수술우월，시일충간단、안전급유효적방법，단시，대우Ⅳ형골절，량조균유슬전동통화신슬활동장애。
Objective To compare the effect of arthroscopic and traditonal surgery methods treatment for the fractures of the intercondylar eminence of the tibia during medium and long term .Methods During February 2003 and September 2011 ,65 patients including 28 male and 37 female patients , who had fractures of the intercondylar eminence of the tibia resulted from acute trauma ,were treated in our department .Surgery was indicated 20 cases in type Ⅱ,29 cases in type Ⅲand 16 cases in type Ⅳfractures of the intercondylar eminence of the tibia ,as classified according to the Meyers and McKeveer system and Zaricznyj system .Traditional arthrotomy surgery was performed in 32 patients and 33 patients had undergone arthroscopic surgery .All patients had X-ray films before operation .After follow-up 3,6,12 and 36 months,they all examined by X-ray of the eminence in an appropriate position was found on X-ray films in all patients .Union time is from 6 to 12 weeks and evaluated by Lysholm system .Results After a follow-up ranging from 24 to 43 months and the average period was 36 months.A total of 65 patients turned up.The outcome of treatment was evaluated on the basis of X-ray and clinical findings in arthroscopic surgery group and tradition surgery group.Union and average time was 8 weeks.During the follow-up time,clinical evaluation included the range of motion and knee joint stability was examined and no knee joint instability and abnormal activity were found.During the 3 months and 6 months,the joint function of knee was evaluated by Lysholmc system ,there was no statistically significant differences between arthroscopic surgery group and tradition surgery group ( P>0.05 ) .But during the follow-up from 12 to 24 months,there were significant differences between arthroscopic surgery group and tradition surgery group according to Lysholm system ( P <0.05 ) .As for type Ⅳ fractures of the intercondylar eminence of the tibia ,there was no statistically significant differences between arthroscopic surgery group and tradition surgery group ( P>0.05 ) according to Lysholm system ,clinical evaluation included range of motion and knee pain was examined and knee pain and abnormal activity were found in this two groups .Conclusions Arthroscopy is considered the most suitable technique for the treatment of fractures of the intercondylar eminence of the tibia , because it is minimally invasive ,safe and effective .The medium and long term effect of outcome is much better than the traditional surgery for the intercondylar eminence of the tibia .But as for type Ⅳfractures,the patients in the two groups all have knee pain and abnormal activity .