目的 分析关节镜辅助微创经皮钢板接骨术（minimal y invasive percutaneous plate osteosynthesis，MIPPO）治疗老年Schatzker II~III型胫骨平台骨折的疗效及预后。 方法 选取本院老年Schatzker II~III型胫骨平台骨折患者43例，按手术方式分为观察组（关节镜辅助MIPPO，19例）和对照组（切开复位内固定术，24例），比较两组术后近期疗效、近远期并发症及远期生活质量差异。 结果 观察组较对照组，切口长度、住院时间、骨愈合时间均显著缩短，术中出血量、术后引流量均显著减少，均P<0.05。观察组较对照组，切口感染、皮肤坏死率、延迟愈合、关节僵硬及创伤性关节炎等术后并发症比率显著降低，均P<0.05。观察组术后Rasmussen功能及放射学评分优良率均显著高于对照组，均P<0.05。两组患者治疗后生活质量各项评分均显著高于治疗前，均P<0.05。 结论 关节镜辅助MIPPO技术治疗老年Schatzker II~III型胫骨平台骨折，创伤及近、远期并发症有效降低，恢复显著加快，生活质量显著提高。
Abstract
Objective To analyze the efficacy and prognosis of arthroscopy-assisted minimally invasive percutaneous plate osteosynthesis (MIPPO) technology in the treatment of elderly Schatzker type II-III tibial plateau fractures. Methods Forty-three patients with Schatzker type II-III tibial plateau fracture in our hospital were divided into an observation group (arthroscopy-assisted MIPPO technique, 19 cases) and a control group (traditional incision and reduction and internal fixation, 24 cases) according to the surgical method. The short-term effects after operation, short-term complications, and long-term quality of life in two groups were compared. Results Compared with the control group, the incision length, length of hospital stay, and bone healing time of the observation group were much shorter, the intraoperative blood loss and postoperative drainage volume significantly reduced (all P<0.05). The rates of incision infection, skin necrosis, delayed healing, joint stiffness, and traumatic arthritis of the observation group were much lower than those of the control group (all P<0.05). The Rasmussen function and radiological scores of the observation group were much higher than those of the control group (all P<0.05). The scores of the two groups of patients after treatment were significantly higher than those before the treatment (both P<0.05). Conclusions Arthroscopy-assisted MIPPO technique for the treatment of elderly Schatzker type II-III tibial plateau fractures effectively reduces trauma and near-term complications, significantly accelerates recovery, and significantly improves quality of life.
关键词
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胫骨平台骨折； 经皮接骨板内固定； 关节镜； MIPPO技术； 预后
Key words
Tibial plateau fracture /
Minimally invasive percutaneous plate osteosynthesis /
Arthroscopy /
MIPPO technique /
Prognosis
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参考文献
[1] Wang QM, Yu JW, Zhong ZY, et al. Subdivision of injured area for Schatzker IV tibial plateau fracture repair: a report of 12 cases[J]. J Orthop Sci, 2020, 25(3): 481-486. DOI: 10.1016/j.jos.2019.05.020.
[2] Touloupakis G, Ghirardelli S, Biancardi E, et al. A remarkable pattern of a tibial plateau fracture-use of a safe technique with practical advantages in the surgical field[J]. Acta Biomed, 2019, 90(2): 343-347. DOI: 10.23750/abm.v90i2.6661.
[3] 陈磊, 李江华, 方钦正, 等. 膝关节镜辅助下微创手术与传统手术治疗胫骨平台骨折的临床疗效比较[J]. 中国内镜杂志, 2017, 23(11): 36-40. DOI: 10.3969/j.issn.1007-1989.2017.11.007.
[4] Lee KW, Yang DS, Hwang JY, et al. Arthroscopic assessment of cartilage healing status after treatment of tibial plateau fracture[J]. Indian J Orthop, 2019, 53(2): 257-262. DOI: 10.4103/ortho.IJOrtho_190_17.
[5] 彭磊. 膝关节镜辅助经皮内固定治疗胫骨平台骨折的价值研究[J]. 重庆医学, 2017, 46(A1): 345-347.
[6] 李冬尧, 张会久, 胡雅光. 关节镜辅助下经皮内固定与传统切开复位内固定治疗SchatzkerⅠ~Ⅳ型胫骨平台骨折的疗效对比[J]. 中国内镜杂志, 2017, 23(6): 58-65. DOI: 10.3969/j.issn.1007-1989. 2017. 06.013.
[7] Rasmussen PS. Tibial condylar fractures. Impairment of knee joint stability as an indication for surgical treatment[J]. J Bone Joint Surg Am, 1973, 55(7): 1331-1350. PMID: 4586086.
[8] 李鲁, 王红妹, 沈毅. SF-36健康调查量表中文版的研制及其性能测试[J]. 中华预防医学杂志, 2002, 36(2): 109-113. DOI:10.3760/j:issn:0253-9624.2002.02.011.
[9] 辛宏立. 32例胫骨平台骨折的治疗总结[J]. 中国现代医生, 2007, 45(7S): 51. DOI: 10.3969/j.issn.1673-9701.2007.07.036.
[10] 于沂阳, 常恒瑞, 李石伦, 等. 2010年至2011年中国东部地区与西部地区成人胫骨平台骨折的流行病学对比分析[J]. 中华创伤骨科杂志, 2017, 19(10): 861-865. DOI: 10.3760/cma.j.issn.1671-7600. 2017. 10. 006.
[11]Jiang LJ, Zheng Q, Pan ZJ. Comparison of extended anterolateral approach in treatment of simple/complex tibial plateau fracture with posterolateral tibial plateau fracture[J]. J Orthop Surg Res, 2018, 13(1): 303. DOI: 10.1186/s13018-018-1007-7.
[12] 曾杉, 贺振年, 戴波, 等. 创伤性胫骨平台骨折术后切口感染患者的病原菌分布与危险因素分析[J]. 中华医院感染学杂志, 2017, 27(16): 3729-3732. DOI: 10.11816/cn.ni.2017-170240.
[13] 陈志伟, 廖瑛, 戴祝, 等. 关节镜辅助下仿MIPPO技术治疗B型胫骨平台骨折[J]. 中国矫形外科杂志, 2006, 14(8): 627-628. DOI: 10.3969/j.issn.1005-8478.2006.08.023.
[14] Pagkalos J, Molloy R, Snow M. Bi-planar intra-articular deformity following malunion of a Schatzker V tibial plateau fracture: correction with intra-articular osteotomy using patient-specific guides and arthroscopic resection of the tibial spine bone block[J]. Knee. 2018, 25(5): 959-965. DOI: 10.1016/j.knee.2018.05.015.
[15] 周广伟, 杜桂夏, 张景涛, 等. 复杂胫骨平台骨折术后感染病原学特点及影响因素与对策研究[J]. 中华医院感染学杂志, 2018, 28(23): 108-111. DOI: 10.11816/cn.ni.2018-174030.
[16] 董泽民, 马信文, 边绍清. 不同外科治疗方案在胫骨平台骨折不愈并发慢性感染患者中的疗效[J]. 中华医院感染学杂志, 2017, 27(6): 1337-1340. DOI: 10.11816/cn.ni.2016-163472.
[17] Sinha S, Singh M, Saraf SK, et al. Fixation of posterior tibial plateau fracture with additional posterior plating improves early rehabilitation and patient satisfaction[J]. Indian J Orthop, 2019, 53(3): 472-478. DOI:10.4103/ortho.IJOrtho_295_18.
[18] 吴兆祥, 汪颖, 陈仲, 等. 微创经皮钢板内固定治疗Schatzker Ⅵ型胫骨平台骨折的前瞻性研究[J]. 中华创伤骨科杂志, 2008, 10(1): 17-20. DOI: 10.3760/cma.j.issn.1671-7600.2008.01.005.
基金
2017年度阿克苏地区人才项目（阿地党组传〔2017〕217号-【12】）
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