Zhou Ziguang
Department of Orthopaedics, Pinggu Hospital of Beijing, Beijing 101200, PR China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2009 Nov;23(11):1316-8.
To explore the treatment of low-energy tibial plateau fractures with arthroscopic percutaneous osteosynthesis.
From May 2004 to April 2008, 27 cases of tibial plateau fractures were treated with arthroscopic management. There were 19 males and 8 females, aged 18-61 years old (mean 41.5 years old). Fracture was caused by traffic accident in 18 cases, by falling from height in 6 cases, by bruise in 2 cases, and by other in 1 case. There were 8 cases of type I, 12 cases of type II, 2 cases of type III and 5 cases of type IV according to Schatzker classification. The time from injury to operation was 3-15 days (mean 5.2 days). After symptomatic managements were performed arthroscopically in 11 cases of meniscus tear, 4 cases of medial collateral ligament rupture of knee joint, 3 cases of anterior cruciate ligament rupture of knee joint and 2 cases of cartilage fracture resulting in joint bodies, fracture was reduced and fixed with 2 or 4 cannulated screws (7 mm in diameter). Autograft of ilium was given 6 cases of bone defect. Early functional exercise was done.
The operation time was 55-150 minutes (mean 93 minutes); the hospitalization days were 7-22 days (mean 16 days). All incision healed primarily. Edema of the affected leg occurred in all patients and subsided after 3 days of symptomatic management. In one patient who did not cooperate in functional exercise, adhesion occurred and normal function was recovered after by manual dissolution under conditions of anesthesia after 3 months of operation. All patients were followed up 6-36 months (mean 16.6 months). The range of motion of knee joint was 105-140 degrees (mean 121 degrees). According to Lysholm scale of knee joint, the score was 72-100 points (mean 93.6 points) 6 months after operation. The X-ray film showed no signs of osteoarthritis.
Arthroscopic percutaneous osteosynthesis yields satisfactory results and can be accepted as an alternative and effective method for the treatment of low-energy tibial plateau fractures.
探讨关节镜下经皮接骨术治疗低能量胫骨平台骨折的方法。
2004年5月至2008年4月，对27例胫骨平台骨折患者采用关节镜治疗。其中男19例，女8例，年龄18 - 61岁（平均41.5岁）。骨折原因：交通事故伤18例，高处坠落伤6例，重物砸伤2例，其他原因1例。按Schatzker分型：Ⅰ型8例，Ⅱ型12例，Ⅲ型2例，Ⅳ型5例。受伤至手术时间为3 - 15天（平均5.2天）。关节镜下对11例半月板撕裂、4例膝关节内侧副韧带断裂、3例膝关节前交叉韧带断裂及2例软骨骨折致关节内游离体进行对症处理后，采用2枚或4枚直径7mm的空心螺钉复位固定骨折。6例骨缺损患者取自体髂骨植骨。早期进行功能锻炼。
手术时间55 - 150分钟（平均93分钟）；住院天数7 - 22天（平均16天）。所有切口均一期愈合。所有患者患侧下肢均出现肿胀，经对症处理3天后消退。1例患者因功能锻炼不配合，术后3个月出现粘连，在麻醉下手法松解后恢复正常功能。所有患者随访6 - 36个月（平均16.6个月）。膝关节活动范围为105 - 140度（平均121度）。术后6个月按膝关节Lysholm评分标准，评分72 - 100分（平均93.6分）。X线片显示无骨关节炎征象。
关节镜下经皮接骨术治疗低能量胫骨平台骨折效果满意，可作为一种可供选择的有效治疗方法。
