中华骨与关节外科杂志
中華骨與關節外科雜誌
중화골여관절외과잡지
Chinese Journal Bone and Joint Surgery
2015年
2期
120-124
,共5页
胫骨平台骨折%软组织损伤%关节镜%微创内固定系统
脛骨平檯骨摺%軟組織損傷%關節鏡%微創內固定繫統
경골평태골절%연조직손상%관절경%미창내고정계통
Tibial plateau fractures%Soft tissue injury%Arthroscopy%Less invasive stabilization system
背景：对于胫骨平台骨折，在传统的切开手术中，为了观察关节面的复位情况，要切开关节囊，切断半月板胫骨韧带。而这容易导致术后膝关节粘连、本体感觉障碍、关节疼痛，并增加感染风险，影响患者预后。<br> 目的：探讨关节镜下微创内固定系统（LISS）治疗外侧胫骨平台骨折伴软组织损伤的效果。<br> 方法：本研究纳入2011年9月至2013年6月我院连续收治的外侧胫骨平台骨折合并软组织损伤患者67例。采用随机数字表法将其分为两组：34例采用关节镜下LISS内固定治疗（关节镜组），33例采用传统的切开复位内固定治疗（切开组）。记录两组患者的手术时间、术中出血及住院时间。术后第2天根据X线片评价骨折复位情况，术后1年随访时依据Rasmussen评分系统评价膝关节功能。<br> 结果：关节镜组术中出血显著少于切开组[（97.1±37.9）ml vs（183.8±65.4）ml，t＝5.366，P＜0.05]，但手术时间和住院时间两项比较无显著统计学差异（P＞0.05）。术后第2天X线检查结果显示关节镜骨折复位的优良率显著高于切开组（91.2%vs 78.8%，χ2＝4.213，P＜0.05）。所有患者获得12~36个月，平均（15.8±3.7）个月随访。术后1年随访时，关节镜组的膝关节功能优良率显著优于切开组（85.3%vs 69.7%，χ2＝6.329，P＜0.05）。<br> 结论：关节镜下LISS固定治疗外侧胫骨平台骨折伴软组织损伤的效果确切。
揹景：對于脛骨平檯骨摺，在傳統的切開手術中，為瞭觀察關節麵的複位情況，要切開關節囊，切斷半月闆脛骨韌帶。而這容易導緻術後膝關節粘連、本體感覺障礙、關節疼痛，併增加感染風險，影響患者預後。<br> 目的：探討關節鏡下微創內固定繫統（LISS）治療外側脛骨平檯骨摺伴軟組織損傷的效果。<br> 方法：本研究納入2011年9月至2013年6月我院連續收治的外側脛骨平檯骨摺閤併軟組織損傷患者67例。採用隨機數字錶法將其分為兩組：34例採用關節鏡下LISS內固定治療（關節鏡組），33例採用傳統的切開複位內固定治療（切開組）。記錄兩組患者的手術時間、術中齣血及住院時間。術後第2天根據X線片評價骨摺複位情況，術後1年隨訪時依據Rasmussen評分繫統評價膝關節功能。<br> 結果：關節鏡組術中齣血顯著少于切開組[（97.1±37.9）ml vs（183.8±65.4）ml，t＝5.366，P＜0.05]，但手術時間和住院時間兩項比較無顯著統計學差異（P＞0.05）。術後第2天X線檢查結果顯示關節鏡骨摺複位的優良率顯著高于切開組（91.2%vs 78.8%，χ2＝4.213，P＜0.05）。所有患者穫得12~36箇月，平均（15.8±3.7）箇月隨訪。術後1年隨訪時，關節鏡組的膝關節功能優良率顯著優于切開組（85.3%vs 69.7%，χ2＝6.329，P＜0.05）。<br> 結論：關節鏡下LISS固定治療外側脛骨平檯骨摺伴軟組織損傷的效果確切。
배경：대우경골평태골절，재전통적절개수술중，위료관찰관절면적복위정황，요절개관절낭，절단반월판경골인대。이저용역도치술후슬관절점련、본체감각장애、관절동통，병증가감염풍험，영향환자예후。<br> 목적：탐토관절경하미창내고정계통（LISS）치료외측경골평태골절반연조직손상적효과。<br> 방법：본연구납입2011년9월지2013년6월아원련속수치적외측경골평태골절합병연조직손상환자67례。채용수궤수자표법장기분위량조：34례채용관절경하LISS내고정치료（관절경조），33례채용전통적절개복위내고정치료（절개조）。기록량조환자적수술시간、술중출혈급주원시간。술후제2천근거X선편평개골절복위정황，술후1년수방시의거Rasmussen평분계통평개슬관절공능。<br> 결과：관절경조술중출혈현저소우절개조[（97.1±37.9）ml vs（183.8±65.4）ml，t＝5.366，P＜0.05]，단수술시간화주원시간량항비교무현저통계학차이（P＞0.05）。술후제2천X선검사결과현시관절경골절복위적우량솔현저고우절개조（91.2%vs 78.8%，χ2＝4.213，P＜0.05）。소유환자획득12~36개월，평균（15.8±3.7）개월수방。술후1년수방시，관절경조적슬관절공능우량솔현저우우절개조（85.3%vs 69.7%，χ2＝6.329，P＜0.05）。<br> 결론：관절경하LISS고정치료외측경골평태골절반연조직손상적효과학절。
Background:In general, the joint capsule has to be opened and meniscal tibial ligament needs to be cut off in the process of open reduction and internal fixation for the treatment of tibial plateau fracture. It easily leads to postoperative adhesion of the knee, disorder of proprioceptive sense, joint pain, and increased risk of infection. <br> Objective:To investigate the therapeutic effect of arthroscopy combined with less invasive stabilization system (LISS) on tibial plateau fractures accompanied with soft tissue injuries. <br> Methods:A consecutive series of 67 patients, who suffered from lateral tibial plateau fractures accompanied with soft tissue injuries and were treated in our hospital from September 2011 to June 2013, were enrolled in this study and randomly divid-ed into two groups according to random digits table. Of them, 34 patients received LISS under arthroscope (arthroscopy group) and 33 underwent traditional open reduction and internal fixation (control group). Operation time, intraoperative blood loss and hospital stay were recorded. The injured sites were observed by X-ray on day 2 after operation. The knee joint function was evaluated one year after operation according to Rasmussen scoring. <br> Results: Intraoperative blood loss in the arthroscopy group was significantly less than that in the control group ([97.1 ± 37.9] ml vs [183.8±65.4) ml, t=5.366, P<0.05), but there were no significant differences in operation time or hospitalization time between two groups (P>0.05). X-ray showed that the reset of fractures in the arthroscopy group was better than that in the control group (91.2%vs 78.8%,χ2=4.213, P<0.05). The average duration of follow-up was (15.8±3.7) months (range, 12-36 months) in all the patients. After one year of follow-up, the knee function of the arthroscopy group was significantly su-perior to that of the control group (excellent-and-good rate:85.3%vs 69.7%,χ2=6.329, P<0.05). <br> Conclusions:Arthroscopy combined with LISS is an effective treatment for tibial plateau fractures accompanied with soft tissue injuries.
