CAJ | 학술논문

目的对关节镜辅助下经皮内固定和切开复位内固定治疗胫骨平台骨折的临床应用价值进行对比分析.方法对180例胫骨平台骨折患者进行前瞻性的研究,其中胫骨平台Ⅱ型骨折(A组)112例、Ⅲ型骨折(B组)68例.A组和B组分别按入院日期的单双号随机分为A1组、A2组和B1组、B2组.A1组(56例)和B1组(34例)均采取切开复位内固定治疗,A2组(56例)和B2组(34例)均采取关节镜辅助下经皮内固定治疗.将同一类型胫骨平台骨折不同治疗方法下的患者术后功能恢复情况进行评估比较.结果 A组:A1组优12例,良26例,可12例,差6例,优良率为67.9％(38/56)；A2组优19例,良34例,可3例,差0例,优良率为94.6％(53/56).两组优良率比较差异有统计学意义(P＜0.01).A1组和A2组术后膝关节HSS评分及膝关节屈伸活动度比较差异有统计学意义[(73.21±8.32)分比(85.58±9.89)分、(35.6±6.6).比(55.1±8.8).](P＜0.01).B组:B1组优8例,良16例,可7例,差3例,优良率为70.6％(24/34)；B2组优12例,良21例,可1例,差0例,优良率为97.1％(33/34).两组优良率比较差异有统计学意义(P＜0.01).B1组和B2组术后膝关节HSS评分及膝关节屈伸活动度比较差异有统计学意义[(75.32±7.99)分比(86.41±10.21)分、(33.9±7.2).比(56.6±10.5).](P＜0.01).结论关节镜辅助下经皮内固定方法无论治疗Ⅱ型还是Ⅲ型胫骨平台骨折,其疗效都要优于切开复位内固定方法,而且该方法为微创疗法,值得在临床中加以推广应用.
목적 대관절경보조하경피내고정화절개복위내고정치료경골평태골절적림상응용개치진행대비분석.방법 대180례경골평태골절환자진행전첨성적연구,기중경골평태Ⅱ형골절(A조)112례、Ⅲ형골절(B조)68례.A조화B조분별안입원일기적단쌍호수궤분위A1조、A2조화B1조、B2조.A1조(56례)화B1조(34례)균채취절개복위내고정치료,A2조(56례)화B2조(34례)균채취관절경보조하경피내고정치료.장동일류형경골평태골절불동치료방법하적환자술후공능회복정황진행평고비교.결과 A조:A1조우12례,량26례,가12례,차6례,우량솔위67.9％(38/56)；A2조우19례,량34례,가3례,차0례,우량솔위94.6％(53/56).량조우량솔비교차이유통계학의의(P＜0.01).A1조화A2조술후슬관절HSS평분급슬관절굴신활동도비교차이유통계학의의[(73.21±8.32)분비(85.58±9.89)분、(35.6±6.6).비(55.1±8.8).](P＜0.01).B조:B1조우8례,량16례,가7례,차3례,우량솔위70.6％(24/34)；B2조우12례,량21례,가1례,차0례,우량솔위97.1％(33/34).량조우량솔비교차이유통계학의의(P＜0.01).B1조화B2조술후슬관절HSS평분급슬관절굴신활동도비교차이유통계학의의[(75.32±7.99)분비(86.41±10.21)분、(33.9±7.2).비(56.6±10.5).](P＜0.01).결론 관절경보조하경피내고정방법무론치료Ⅱ형환시Ⅲ형경골평태골절,기료효도요우우절개복위내고정방법,이차해방법위미창요법,치득재림상중가이추엄응용.
Objective To compare the value of arthroscopic assisted percutaneous internal fixation and open reduction and internal fixation in treatment of tibial plateau fracture.Methods The clinical data of 180 patients of tibial plateau fracture were analyzed retrospectively,including 112 patients of type Ⅱ fracture (group A) and 68 patients of type Ⅲ fracture (group B).The patients in group A and group B were divided into group A1 (56 patients),A2 (56 patients),B 1 (34 patients),B2 (34 patients) respectively according to the odd number and even number of admission date.The patients in group A1 and B1 received open reduction and internal fixation and the patients in group A2 and B2 received arthroscopic assisted percutaneous internal fixation.The postoperative functional recovery was compared and evaluated between the same type of tibial plateau fractures under different treatments.Results In group A1:the postoperative functional recovery,the excellent was 12 patients,the good was 26 patients,the middle good was 12 patients,the bad was 6 patients.The rate of the excellent and the good was 67.9％ (38/56).In group A2:the postoperative functional recovery,the excellent was 19 patients,the good was 34 patients,the middle good was 3 patients.The rate of the excellent and the good was 94.6％(53/56).The rate of the excellent and the good between group A1 and group A2 had significant difference (P ＜ 0.01).After operation for 6 months,the HSS scores of knee joint and degree of flex and extend in group A1 and A2 had significant difference [(73.21 ± 8.32) scores vs.(85.58 ±9.89) scores,(35.6 ±6.6)° vs.(55.1 ±8.8)°] (P ＜0.01).In group B1:the postoperative functional recovery,the excellent was 8 patients,the good was 16 patients,the middle good was 7 patients,the bad was 3 patiens.The rate of the excellent and the good was 70.6％(24/34).In group B2:the postoperative functional recovery,the excellent was 12 patients,the good was 21 patients,the middle good was 1 patient.The rate of the excellent and the good was 97.1％(33/34).The rate of the excellent and the good between group B1 and group B2 had significant difference(P ＜ 0.01).After operation for 6 months,the HSS scores of knee joint and degree of flex and extend in group B1 and B2 had significant difference [(75.32 ± 7.99) scores vs.(86.41 ±10.21) scores,(33.9 ±7.2)° vs.(56.6 ± 10.5)°](P＜0.01).Conclusions The efficacy of arthroscopic assisted percutaneous internal fixation is better than open reduction and internal fixation either in type Ⅱ fracture or in type Ⅲ fracture.This method is mini-invasive and is worthy to spread.