| 关节镜联合微创经皮钢板内固定治疗低能量胫骨平台骨折伴韧带损伤的临床研究 |
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Received:June 13, 2019
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| 作者 | Author | 单位 | Unit | E-Mail |
| 曹建国 |
CAO Jian-guo |
玉环市人民医院骨科, 浙江 玉环 317600 |
Department of Orthopaedics, People's Hospital of Yuhuan City, Yuhuan 317600, Zhejiang, China |
2277203361@qq.com |
| 陈宇 |
CHEN Yu |
玉环市人民医院骨科, 浙江 玉环 317600 |
Department of Orthopaedics, People's Hospital of Yuhuan City, Yuhuan 317600, Zhejiang, China |
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| 陈文辉 |
CHEN Wen-hui |
玉环市人民医院骨科, 浙江 玉环 317600 |
Department of Orthopaedics, People's Hospital of Yuhuan City, Yuhuan 317600, Zhejiang, China |
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| 龙治强 |
LONG Zhi-qiang |
玉环市人民医院骨科, 浙江 玉环 317600 |
Department of Orthopaedics, People's Hospital of Yuhuan City, Yuhuan 317600, Zhejiang, China |
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| 金文锦 |
JIN Wen-jin |
玉环市人民医院骨科, 浙江 玉环 317600 |
Department of Orthopaedics, People's Hospital of Yuhuan City, Yuhuan 317600, Zhejiang, China |
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| 期刊信息：《中国骨伤》2019年32卷，第11期，第1008-1013页 |
| DOI：10.3969/j.issn.1003-0034.2019.11.007 |
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目的：比较关节镜联合微创经皮钢板内固定（minimally invasive percutaneous plate osteosynthesis，MIPPO）与切开复位内固定治疗低能量胫骨平台骨折伴韧带损伤患者的临床疗效。
方法：选取自2016年3月至2017年3月收治的60例胫骨平台骨折伴韧带损伤患者，分为A、B两组，每组30例。A组采用关节镜联合MIPPO治疗，其中男14例，女16例；年龄30~63（47.25±5.36）岁；按照Schatzker分型，Ⅰ型8例，Ⅱ型12例，Ⅲ型10例。B组采用切开复位内固定治疗，其中男16例，女14例；年龄32~60（43.39±4.62）岁；按照Schatzker分型，Ⅰ型10例，Ⅱ型11例，Ⅲ型9例。观察并比较两组患者影像学指标、切口长度、术后引流量、术中出血量、并发症、术后下床时间、住院时间等，术后18个月采用HSS评分评价膝关节功能恢复情况。
结果：60例患者均获得随访，时间12~24个月，平均18个月。术后3 d及术后12个月两组胫骨平台内翻角、后倾角、股胫角比较差异无统计学意义（P>0.05）。两组术前膝关节间隙宽度比较差异无统计学意义，术后12个月B组膝关节间隙宽度（6.59±0.71）mm大于A组（4.25±0.65）mm。A组2例出现并发症，B组6例出现并发症，两组比较差异有统计学意义（P<0.05）。A组切口长度、住院时间、术后引流量、术中出血量、术后下床时间分别为（5.17±1.89）cm、（2.14±0.65）周、（30.02±3.15）ml、（62.63±9.58）ml、（3.16±1.87）d； B组分别为（16.25±3.47）cm、（4.57±1.09）周、（63.75±9.84）ml、（145.89±12.61）ml、（7.86±2.14）d；两组比较差异有统计学意义（P<0.05）。术后18个月A组HSS评分（87.68±7.39）分，高于B组（69.42±5.13）分（P<0.05）。
结论：关节镜辅助下应用MIPPO术和切开复位内固定术治疗低能量胫骨平台骨折伴韧带损伤患者均能给予坚强持久稳定固定。切开复位操作简单但创伤较大，MIPPO具有创伤小并早期处理韧带半月板损伤，关节功能较好、并发症少等优点。 |
| [关键词]:胫骨骨折 关节镜 骨折固定术,内 创伤和损伤 |
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| Clinical research of arthroscopy with minimally invasive percutaneous plate osteossynesis for low energy tibial plateau fracture with ligament injury |
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Abstract:
Objective: To compare clinical effects of minimally invasive percutaneous plate osteosynthesis(MIPPO) and open reduction and internal fixation under arthroscopy for the treatment of low energy tibial plateau fracture with ligament injury.
Methods: From March 2016 to March 2017,60 tibial plateau fracture patients with ligament injury were divided into A and B groups according to random number table. In group A,there were 30 patients including 14 males and 16 females aged from 30 to 63 years old with an average of (47.25±5.36) years old;8 patients were classified typeⅠ,12 patients were typeⅡ and 10 patients type Ⅲ;treated by MIPPO under arthroscopy. In group B,there were 30 patients including 16 males and 14 females aged from 32 to 60 years old with an average of (43.39±4.62) years old;10 patients were classified to typeⅠ,11 patients were typeⅠand 9 patients type Ⅲ;treated by open reduction and internal fixation. Imaging data,length of incision,postoperative volume of drainage,intraoperative blood loss,complications,postoperative activity time and hospital stays were observed and compared. Postoperative HSS score at 18 months was used to compare recovery of knee joint function.
Results: Sixty patients were followed up for 12 to 24 months with average of 18 months. There were no statistical differences in tilt angle of the tibial plateau (TPA),posterior angle of tibial plateau (PA) and femoro tibial angle (FTA) between two groups at 3 days and 12 months after operation. There was no significance in width of internal joint apace before operation,while group B(6.59±0.71) mm was bigger than group A (4.25±0.65) mm after operation at 12 months. Two patients in group A occurred complications and 6 patients in group B occurred complications,and had differences between two groups(P<0.05). Length of incision,hospital stays,postoperative volume of drainage,intraoperative blood loss and postoperative activity time in group A were(5.17±1.89) cm,(2.14±0.65) weeks,(30.02±3.15) ml,(62.63±9.58) ml,(3.16±1.87)d,respectively;while in group B were(16.25±3.47) cm,(4.57±1.09) weeks,(63.75±9.84) ml,(145.89±12.61) ml,(7.86±2.14) d,respectively;and had statistical differences between two groups(P<0.05). HSS score in group A (87.68±7.39) was higher than that of in group B(69.42±5.13) at 18 months after operation (P<0.05).
Conclusion: Both of MIPPO and open reduction and internal fixation under arthroscopy for low energy tibial plateau fracture with ligament injury could provide stable fixation. Open reduction and internal fixation has advantages of simple operation,but had seriously-injured,MIPPO has advantages of less trauma,good recovery of joint function,less complications and could deal with ligament and meniscus injury. |
| KEYWORDS:Tibial fractures Arthroscopes Fracture fixation,internal Wounds and injuries |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 曹建国,陈宇,陈文辉,龙治强,金文锦.关节镜联合微创经皮钢板内固定治疗低能量胫骨平台骨折伴韧带损伤的临床研究[J].中国骨伤,2019,32(11):1008~1013 |
| 英文格式: | CAO Jian-guo,CHEN Yu,CHEN Wen-hui,LONG Zhi-qiang,JIN Wen-jin.Clinical research of arthroscopy with minimally invasive percutaneous plate osteossynesis for low energy tibial plateau fracture with ligament injury[J].zhongguo gu shang / China J Orthop Trauma ,2019,32(11):1008~1013 |
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