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膝关节镜联合MIPPO技术治疗胫骨平台骨折的疗效分析
Clinical analysis of knee arthroscopy combined with MIPPO technique in the treatment of tibial plateau fracture
  
DOI:
中文关键词:  胫骨平台骨折  膝关节镜  微创手术  经皮微创钢板内固定术
英文关键词:Tibial plateau fracture  Knee arthroscopy  Minimally invasive surgery  Minimally invasive percutaneous plate osteosynthesis
基金项目:
作者单位
姜勇1 张爱华2 徐圣康3 赵猛3 王希3  
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中文摘要:
      目的 比较膝关节镜联合MIPPO技术复位内固定与切开复位内固定治疗胫骨平台骨折的临床疗效及安全性。方法 回顾性分析2018 年7 月至2020 年7 月期间十堰市太和医院创伤骨科收治的76 例Schatzker Ⅰ-Ⅲ型胫骨平台骨折患者资料。依据手术方式不同分为膝关节镜联合MIPPO技术微创内固定组(A组)35 例和传统切开复位内固定组(O组)41例。记录并比较两组患者的手术时间、切口长度、术中失血量、术后引流量、膝关节内软组织损伤情况、住院时间、术后下床活动时间、术后Rasmussen 放射评分、骨折愈合时间、术后并发症发生情况、术后1、2、3、6个月时膝关节HSS功能评分及术后12个月时HSS评分优良率,评估两组手术方式的临床疗效。结果 A组手术时间较O组长,差异具有统计学意义(P<0.05);A组术中失血量、术后引流量少于O组,膝关节内软组织损伤者较O组多,差异具有统计学意义(P<0.05);A组切口长度、术后下床活动时间、骨折愈合时间均较O组短,差异具有统计学意义(P<0.05);两组住院时间比较差异无统计学意义(P>0.05)。A组术后Rasmussen放射评分高于O组,差异具有统计学意义(P<0.05);A组术后1、2、3、6个月时膝关节功能HSS评分均较O组高,差异具有统计学意义(P<0.05);两组患者术后12个月时膝关节HSS功能评分优良率比较,差异无统计学意义(P>0.05)。结论 两种方式治疗Schatzker Ⅰ-Ⅲ型胫骨平台骨折均有良好的临床疗效,但在膝关节镜辅助下联合MIPPO技术治疗胫骨平台骨折可以精准诊断和治疗膝关节内损伤的软组织,具有手术创伤小、视野清晰、骨折复位质量高、骨折愈合快、术后膝关节功能恢复快等优点,有利于患者术后早期快速康复,是治疗Schatzker Ⅰ-Ⅲ型胫骨平台骨折的较好方法。
英文摘要:
      Objective To compare the clinical efficacy and safety of knee arthroscopy combined with MIPPO reduction and internal fixation with open reduction and internal fixation in the treatment of tibial plateau fractures. Methods Included in this retrospective study were 76 patients who had been admitted in Taihe Hospital from July 2018 to July 2020 for Schatzker type Ⅰ - Ⅲ tibial plateau fracture. According to the different surgical plans, they were divided into knee arthroscopy combined with MIPPO minimally invasive internal fixation group (group A, 35 cases) and traditional open reduction and internal fixation group (group O, 41 cases). The two groups were compared in terms of operation time, incision length, intraoperative blood loss, postoperative drainage, soft tissue injury in the knee joint hospital stay, postoperative ambulation, postoperative Rasmussen radiation score, fracture healing time, postoperative complications, knee function HSS score at 1, 2, 3 and 6 months after operation, and the excellent and good rate of HSS score at 12 months after operation. Results The operation time of group A was longer than that of group O, the number of patients with soft tissue injury in the knee joint of group A was more than that of group O, and the difference was statistically significant (P<0.05). The intraoperative blood loss and postoperative drainage in group A were significantly lower than those in group O, with statistically significant differences (P<0.05). The incision length, postoperative ambulation and fracture healing time in group A were significantly shorter than those in group O, with statistically significant differences(P<0.05). There was no significant difference between the two groups in hospital stay (P>0.05). The postoperative Rasmussen radiation score in group A was significantly higher than that in group O, with statistically significant differences (P<0.05). The knee function HSS score at 1, 2, 3 and 6 months after operation in group A was significantly higher than that in group O, with statistically significant differences (P<0.05). There was no significant difference between the two groups in the excellent and good rate of knee function HSS score at 12 months after operation. Conclusion Both surgical methods have achieved good clinical efficacy in the treatment of tibial plateau fractures of Schatzker types Ⅰ - Ⅲ . However, in the treatment of tibial plateau fracture with the assistance of knee arthroscopy combined with MIPPO technique, the injured soft tissue of knee joint can be diagnosed and treated accurately, which has the advantages of smaller surgical trauma, clearer view of operation, good quality of fracture reduction, shorter fracture healing time and faster recovery of knee joint function. It is beneficial to the early recovery of patients after operation, and is a good method for the treatment of Schatzker type Ⅰ-Ⅲ tibial plateau fractures.
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