Lobenhoffer P, Schulze M, Gerich T, Lattermann C, Tscherne H
Department of Trauma Surgery, Hannover Medical School, Germany.
J Orthop Trauma. 1999 Aug;13(6):426-31. doi: 10.1097/00005131-199908000-00006.
To evaluate arthroscopic versus fluoroscopic reduction and percutaneous fixation of lateral tibial plateau fractures of AO/OTA Types 41.B1 to 41.B3.
Prospective study.
University hospital.
One hundred sixty-eight patients underwent operative treatment for a tibial plateau fracture from 1988 to 1995. Thirty-three of these patients had monocondylar fractures of the lateral plateau that were treated by percutaneous reduction and fixation techniques. In the first ten cases, arthroscopic control of reduction was used. The following twenty-three consecutive cases were treated by reduction and fixation solely under fluoroscopic control. The arthroscopy group was followed for a mean of fifty-two months and the fluoroscopy group for thirty-eight months.
Nine of ten cases of the arthroscopy group had an excellent or good result in Rasmussen's knee score at follow-up. One patient with an unreduced anterolateral depression zone despite arthroscopic surgery required a total knee prosthesis after eighteen months. Sixteen cases in the fluoroscopy group met the follow-up criteria. Fifteen were graded good or excellent in Rasmussen's clinical score; sixteen were excellent or good in the radiological score. One patient claimed chronic medial joint line pain after a lateral split fracture and had arthroscopy revealing chondral degeneration on the medial side but had no pathological findings in the lateral compartment. No secondary meniscus or ligament surgery was performed in the follow-up period.
Percutaneous treatment of fractures of the tibial plateau can be performed using arthroscopy as well as image intensification to control reduction of the joint surface. We were not able to demonstrate any significant benefit from arthroscopy compared with fluoroscopic reduction. Reduction under image intensification is technically easier in our practice, especially in serial fractures and multiply injured patients. We reserve arthroscopy for cases with significant ligament injuries and for children with fractures of the median eminence.
评估关节镜辅助与透视下复位及经皮固定AO/OTA 41.B1至41.B3型胫骨外侧平台骨折的效果。
前瞻性研究。
大学医院。
1988年至1995年间，168例患者接受了胫骨平台骨折的手术治疗。其中33例为外侧平台单髁骨折，采用经皮复位固定技术治疗。前十例采用关节镜辅助复位。随后连续的23例仅在透视控制下进行复位和固定。关节镜组平均随访52个月，透视组平均随访38个月。
关节镜组10例患者中，9例在随访时Rasmussen膝关节评分结果为优或良。1例患者尽管接受了关节镜手术，但前外侧凹陷区仍未复位，18个月后需要行全膝关节置换术。透视组16例患者符合随访标准。15例患者Rasmussen临床评分为良或优；16例患者影像学评分为优或良。1例患者外侧劈裂骨折后出现慢性内侧关节线疼痛，关节镜检查显示内侧软骨退变，但外侧间室无病理改变。随访期间未进行二次半月板或韧带手术。
胫骨平台骨折的经皮治疗可采用关节镜或影像增强技术来控制关节面复位。与透视下复位相比，我们未能证明关节镜有任何显著优势。在我们的实践中，影像增强下复位在技术上更容易，尤其是对于多发骨折和多处受伤的患者。对于伴有严重韧带损伤的病例以及髁间嵴骨折的儿童，我们保留关节镜治疗。
