Dei Giudici Luca, Di Muzio Francesca, Bottegoni Carlo, Chillemi Claudio, Gigante Antonio
Clinical Orthopaedics, Department of Clinical and Molecular Science, School of Medicine, Università Politecnica delle Marche, Via Tronto, 10/A, 60126, Ancona, Italy,
Eur J Orthop Surg Traumatol. 2015 Jul;25(5):807-13. doi: 10.1007/s00590-015-1601-x. Epub 2015 Jan 30.
The management of articular fracture is always a matter of concern. While each articular fracture is different from one another, besides the classification system used and the surgical or non-surgical indication given by the specialist, main goals remain the same: anatomical reduction, stable fixation, loose body removal, and minimal invasiveness. Open procedures are the actual compromise, but unfortunately, it is not always possible to perfectly meet every treatment goal, associated lesions could pass unnoticed or delayed in treatment, and even in a best-case scenario, there could be several complications developing in the long term. In the last decades, arthroscopic joint surgery underwent an exponential evolution, expanding its application also in the trauma field with the development of arthroscopic and arthroscopically assisted reduction and internal fixation (ARIF) techniques; main advantages are an accurate diagnosis of fracture and associated soft tissue involvement, the potential for concomitant treatments, anatomical reduction, and minimal invasiveness. ARIF techniques have been applied to treat fractures affecting several joints: shoulder, elbow, wrist, hip, knee, and ankle. The purpose of this paper was to provide a review of the most recent literature about arthroscopic and arthroscopically assisted reduction and internal fixation for articular and periarticular fractures of the lower limb, analyzing the results and suggesting clinical applications.
关节骨折的处理一直备受关注。虽然每例关节骨折各不相同,但除了所采用的分类系统以及专科医生给出的手术或非手术指征外,主要目标始终相同:解剖复位、稳定固定、清除游离体以及微创。开放手术实际上是一种折衷办法,但遗憾的是,并非总能完美实现每一个治疗目标,相关损伤可能未被察觉或治疗延迟,即便在最佳情况下,长期也可能出现多种并发症。在过去几十年里,关节镜手术经历了指数级发展,随着关节镜及关节镜辅助复位与内固定(ARIF)技术的发展,其在创伤领域的应用也不断扩大;主要优势在于能准确诊断骨折及相关软组织损伤、具备同时进行其他治疗的可能性、实现解剖复位以及微创。ARIF技术已应用于治疗累及多个关节的骨折:肩、肘、腕、髋、膝和踝关节。本文旨在对有关下肢关节内及关节周围骨折的关节镜及关节镜辅助复位与内固定的最新文献进行综述,分析结果并提出临床应用建议。