Cassard X, Beaufils P, Blin J L, Hardy P
Service de Chirurgie Orthopédique et Traumatologique, Centre Hospitalier de Versailles, Le Chesnay.
Rev Chir Orthop Reparatrice Appar Mot. 1999 Jun;85(3):257-66.
Arthroscopic treatment of tibial plateau fractures may reduce morbidity compared to open articular surgery. But bony fixation is necessarily percutaneous and minimal. The purpose of our study was not only to assess immediate results but also long term functional and anatomic results after arthroscopic treatment of tibial plateau fractures, with special reference to radiographical results.
Twenty-six patients (mean age 42 years, range 18 to 70 years, 17 men, 9 women) were arthroscopically treated for a fresh tibial plateau fracture. According to Schatzker classification, there was 2 type I, 17 type II, 6 type III and 1 type IV. No type V or VI were treated in this series. The fixation device was: percutaneous cannulated screw in 23 cases, Kirchner wire in 2 cases, and bone cement filing of the fracture site in 1 case. We did not use cancellous bone graft but we used a hydroxyapatite plug in one case. There were 8 meniscal injuries: 2 underwent arthroscopic suture, 1 had partial meniscectomy and 5 were left in place. Twenty-six cases were suitable for immediate post op follow up. 19 were reviewed at long term. A clinical (Knee Society scoring system) and radiographical examination were done with an average follow-up of 32.7 months.
There were no complications except one immediate postoperative septic osteoarthritis (case with hydroxyapatite plug) and one bony depression of the lateral tibial plateau at the fourth month. Passive motion of the knee started at 1.8 days postop with no pain. Mean flexion at 3 months was 130 degrees. At revision, the average score was: 94.1 for the knee, 94.7 for the function. In two cases we found early signs of osteoarthrosis. There were no secondary bony depression or significant valgus deformity on X-rays.
Arthroscopic management of tibial plateau fractures allows a complete articular screening. Rapid rehabilitation, short hospital stay, and low rate of complications reduce morbidity. The long term results are as good as those with open surgical technique for the types of fracture that we have treated (type III and IV). A minimal, percutaneous osteosynthesis which was the only possibility under arthroscopic control, did not modify the anatomical results.
与开放性关节手术相比，关节镜治疗胫骨平台骨折可能会降低发病率。但骨固定必须经皮进行且创伤最小。我们研究的目的不仅是评估关节镜治疗胫骨平台骨折后的近期效果，还要评估其长期功能和解剖学结果，特别关注影像学结果。
26例患者（平均年龄42岁，范围18至70岁，男性17例，女性9例）接受了关节镜下新鲜胫骨平台骨折治疗。根据Schatzker分类，I型2例，II型17例，III型6例，IV型1例。本系列未治疗V型或VI型骨折。固定装置为：23例采用经皮空心螺钉，2例采用克氏针，1例采用骨折部位骨水泥填充。我们未使用松质骨移植，但1例使用了羟基磷灰石塞。有8例半月板损伤：2例行关节镜下缝合，1例行部分半月板切除术，5例未处理。26例适合术后立即随访。19例进行了长期复查。采用临床（膝关节协会评分系统）和影像学检查，平均随访32.7个月。
除1例术后即刻发生感染性骨关节炎（使用羟基磷灰石塞的病例）和1例在第4个月出现胫骨外侧平台骨凹陷外，无其他并发症。术后1.8天开始进行膝关节被动活动，无疼痛。3个月时平均屈曲度为130度。翻修时，膝关节平均评分为94.1分，功能评分为94.7分。2例发现早期骨关节炎迹象。X线检查未发现继发性骨凹陷或明显外翻畸形。
关节镜治疗胫骨平台骨折可进行完整的关节检查。快速康复、住院时间短和并发症发生率低可降低发病率。对于我们所治疗的骨折类型（III型和IV型），长期结果与开放手术技术一样好。在关节镜控制下唯一可行的微创经皮骨内固定术并未改变解剖学结果。
