胫骨平台骨折治疗：切开复位内固定术与微创内固定系统治疗的临床与放射学比较。
Tibial plateau fracture management: ARIF versus ORIF - clinical and radiological comparison.
机构信息
Département de chirurgie orthopédique et de traumatologie, hôpital Nord, chemin des Bourrely, 13015 Marseille, France.
Département de chirurgie orthopédique et de traumatologie, hôpital Nord, chemin des Bourrely, 13015 Marseille, France.
出版信息
Orthop Traumatol Surg Res. 2019 Feb;105(1):101-106. doi: 10.1016/j.otsr.2018.10.015. Epub 2018 Dec 21.
INTRODUCTION
Arthroscopy has enabled minimally invasive procedures to be developed to treat tibial plateau fracture. The aim of the present study was to assess and compare clinical and radiological results between arthroscopically assisted reduction and internal fixation (ARIF) and open reduction and internal fixation (ORIF) procedures. The study hypothesis was that, in selected tibial plateau fractures, ARIF provides (1) clinical results comparable to those of ORIF, and (2) satisfactory reduction and stable fixation.
MATERIAL AND METHOD
A retrospective multicenter study included adult patients with tibial plateau fracture (Schatzker I to III), over the period January 2010 to December 2014, enabling a minimum 2 years' follow-up. Clinical and radiological data (RoM, IKDC, HSS, Lysholm) were collected at 3, 6 and 12 months and at last follow-up. A total of 317 patients (317 fractures), aged 48±14 years (range, 18-82 years) were followed up for 38±23 months (range, 24-90 months), with 77 fractures (24%) in the ARIF group and 240 (76%) in the ORIF group.
RESULTS
Clinically, there were no significant inter-group differences for active flexion, passive or active extension or Lysholm and IKDC scores, with significant differences for HSS (ARIF: 74±29; ORIF: 70±31; p<0.01) and passive flexion (ARIF: 130±19° (range, 80-160°); ORIF: 130±15.965° (range, 60-140°); p<0.05). Radiologically, there were no significant inter-group differences for reduction quality, lower-limb mechanical axis or signs of osteoarthritis. There were no secondary displacements. There were 7 complications (7/77, 9%) in the ARIF group and 18 (18/240, 8%) in the ORIF group, and 6 surgical revisions for early infection (2 ARIF, 4 ORIF), with no significant inter-group differences.
DISCUSSION
The study hypothesis was confirmed: in Schatzker I-III fractures, ARIF provided clinical results comparable to those of ORIF, with satisfactory reduction and stable fixation. ARIF has its place in the treatment of tibial plateau subsidence and/or separation fracture.
LEVEL OF EVIDENCE
III, retrospective comparative study.
简介
关节镜的出现使得微创技术得以发展，从而治疗胫骨平台骨折。本研究旨在评估和比较关节镜辅助复位内固定（ARIF）与切开复位内固定（ORIF）治疗胫骨平台骨折的临床和影像学结果。研究假设是，在选择的胫骨平台骨折中，ARIF 提供：（1）与 ORIF 相当的临床结果；（2）满意的复位和稳定的固定。
材料和方法
回顾性多中心研究纳入了 2010 年 1 月至 2014 年 12 月期间的成人胫骨平台骨折（Schatzker I 至 III 型）患者，随访时间至少 2 年。在术后 3、6 和 12 个月以及末次随访时收集临床和影像学数据（ROM、IKDC、HSS、Lysholm）。共随访 317 例患者（317 处骨折），年龄 48±14 岁（18-82 岁），随访时间为 38±23 个月（24-90 个月）。ARIF 组 77 例（24%），ORIF 组 240 例（76%）。
结果
临床方面，两组间主动屈伸、被动或主动伸膝、Lysholm 和 IKDC 评分无显著差异，HSS 评分（ARIF：74±29；ORIF：70±31；p<0.01）和被动屈曲（ARIF：130±19°（范围，80-160°）；ORIF：130±15.965°（范围，60-140°）；p<0.05）有显著差异。影像学方面，两组间复位质量、下肢机械轴和骨关节炎征象无显著差异。无继发性移位。ARIF 组有 7 例（7/77，9%）并发症，ORIF 组有 18 例（18/240，8%），6 例早期感染行手术翻修（2 例 ARIF，4 例 ORIF），两组间无显著差异。
讨论
研究假设得到证实：在 Schatzker I-III 型骨折中，ARIF 提供的临床结果与 ORIF 相当，复位满意，固定稳定。ARIF 在治疗胫骨平台塌陷和/或分离骨折中有其地位。
证据水平
III 级，回顾性比较研究。
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