Attmanspacher W, Dittrich V, Staiger M, Stedtfeld H W
Klinik für Unfallchirurgie Klinikum Nürnberg Süd, Germany.
Zentralbl Chir. 2002 Oct;127(10):828-36. doi: 10.1055/s-2002-35126.
Since the mid 1980 s the arthroscopically and radiologically controlled management of tibial plateau fractures is an established part of arthroscopic surgery of the knee. The aim of this study is to analyse the results of this method in our patient population. Between January 1, 1994 and December 31, 1998 59 patients were operated under arthroscopic and radiologic control. Of the 59 tibial plateau fractures there were concomitant ligamentous injuries in 21 cases. In 34 cases an additional arthroscopic procedure was performed (partial meniscectomy 19 times, a meniscal repair 7 times. An arthroscopic procedure was necessary because of chondral lesions 14 times, and in 10 cases a rupture of the ACL was found, which was treated by resection). None of the 8 patients with lateral wedge fracture had a concomitant intraarticular lesion. The intraoperative use of Endobon provided good mechanical stability, but it is not always necessary. The negative aspect of Endobon, however, is the high cost. The number of complications in our series was low (3 intra- and 6 postoperative complications). The average follow-up interval was 48 months. According to the Lysholm-Score, 41 patients investigated obtained an average of 84 points. Because of its good results this procedure can be recommended when conducted by an experienced arthroscopic surgeon. However, the range of indications is limited to special tibial plateau fractures. In case of intraoperative problems or complications we recommend an early change to conventional methods of internal fixation of tibial plateau fractures.
自20世纪80年代中期以来，在关节镜和放射学控制下处理胫骨平台骨折已成为膝关节镜手术的既定组成部分。本研究的目的是分析该方法在我们患者群体中的结果。在1994年1月1日至1998年12月31日期间，59例患者在关节镜和放射学控制下接受了手术。59例胫骨平台骨折患者中，21例伴有韧带损伤。34例患者还进行了额外的关节镜手术（部分半月板切除术19次，半月板修复术7次。因软骨损伤进行关节镜手术14次，10例发现前交叉韧带断裂并进行了切除术）。8例外侧楔形骨折患者均无关节内合并损伤。术中使用Endobon提供了良好的机械稳定性，但并非总是必要。然而，Endobon的缺点是成本高。我们系列中的并发症数量较少（3例术中并发症和6例术后并发症）。平均随访时间为48个月。根据Lysholm评分，41例接受调查的患者平均得分为84分。由于其良好的效果，该手术由经验丰富的关节镜外科医生进行时可被推荐。然而，其适应证范围仅限于特殊的胫骨平台骨折。如果术中出现问题或并发症，我们建议尽早改为传统的胫骨平台骨折内固定方法。
