目的 比较关节镜辅助复位内固定术(arthroscopically-assisted reduction and internal fixation,ARIF)与切开复位内固定术(open reduction and internal fixation,ORIF)治疗胫骨平台后外侧骨折疗效差异.方法 选取我院在 2021 年 1 月至 2022 年 6 月接受 ARIF 或 ORIF 治疗的胫骨平台后外侧骨折患者,根据年龄和性别,按照 1∶1 进行倾向性评分匹配,最终 ARIF 患者和 ORIF 患者均入组 47 例.收集患者围术期临床资料.采用美国特种外科医院膝关节评分(Hospital for Special Surgery knee score,HSS)评分评估膝关节症状及功能评估.采用 Rasmussen 放射评分评估影像学参数并测量及比较胫骨平台宽度(tibial plateau width,TPW),关节凹陷深度(articular depression depth,ADD),胫骨近端内侧角(medial proximal tibial angle,MPTA)和近端胫骨角(proximal tibial slope angle,PTSA).结果 ARIF 组手术时间[(143.52±14.65)min vs.(79.21±15.14)min]、术中曝光次数[(6.41±2.02)次 vs.(4.15±1.78)次]高于 ORIF 组(P<0.05),术中出血量[(75.62±9.58)ml vs.(175.26±10.05)ml]、切口长度[(7.98±2.22)cm vs.(12.05±2.65)cm]、术后引流量[(62.74±4.74)ml vs.(76.74±4.89)ml]和术后住院时间[(1.54±1.05)周 vs.(2.41±1.14)周]低于 ORIF 组(P<0.05).术后 12 个月,ARIF 组 HSS 评分[(185.49±3.14)分 vs.(71.91±4.14)分]高于 ORIF 组(P<0.05);ARIF 组患侧膝关节活动度(range of motion,ROM)[(128.89±7.36)° vs.(125.76±7.55)°]高于 ORIF组(P<0.05)且与对侧膝关节 ROM差值更小[(-3.48±0.97)° vs.(-7.36±1.01)°](P<0.05).术后 12个月,ARIF组 Rasmussen放射学评分[(14.79±3.17)分 vs.(12.24±4.25)分]高于 ORIF组(P<0.05).ARIF组术后6 个月[(1.37±1.31)mm vs.(2.13±1.33)mm]和 12 个月[(2.12±1.12)mm vs.(2.71±1.25)mm]的 ADD 低于 ORIF 组(P<0.05).结论 ARIF 和 ORIF 治疗胫骨平台后外侧骨折患者均可提供令人满意的治疗结果,但ARIF有更好复位效果及功能恢复.ARIF可作为常规胫骨平台后外侧骨折首选治疗方法.
Efficacy and experience of arthroscopy-assisted reduction and internal fixation for posterior lateral tibial plateau fractures
Objective To compare the difference in efficacy between arthroscopically-assisted reduction and internal fixation(ARIF)and open reduction and internal fixation(ORIF)in the treatment of posterior posterolateral tibial plateau fractures.Methods Patients with posterior lateral tibial plateau fracture who were treated with ARIF or ORIF in our hospital from January 2021 to June 2022 were selected and matched by propensity score according to age and gender in a 1:1 manner,and finally 47 patients were enrolled in both ARIF and ORIF group.Perioperative clinical data of the affected patients were collected.Hospital for special surgery knee score(HSS)was assessed for knee symptoms and functional assessment.Imaging parameters were assessed using the Rasmussen radiological score,and the tibial plateau width(TPW),articular depression depth(ADD),proximal medial tibial angulation(MPTA)and proximal tibial angulation(PTSA)were measured and compared.Results The operative time[(143.52±14.65)min vs.(79.21±15.14)min]and intraoperative exposure[(6.41±2.02)vs.(4.15±1.78)]were higher in the ARIF group than that in the ORIF group(P<0.05);the intraoperative bleeding volume[(75.62±9.58)ml vs.(175.26±10.05)ml],incision length[(7.98±2.22)cm vs.(12.05±2.65)cm],postoperative drainage[(62.74±4.74)ml vs.(76.74±4.89)ml]and postoperative hospital stay[(1.54±1.05)weeks vs.(2.41±1.14)weeks]were lower than that in the ORIF group(P<0.05).At 12 months after surgery,the HSS score[(185.49±3.14)vs.(71.91±4.14)]was higher in the ARIF group than in the ORIF group(P<0.05);the ROM of the affected knee joint[(128.89±7.36)° vs.(125.76±7.55)°]was higher in the ARIF group than in the ORIF group(P<0.05),and the difference in ROM of the affected knee joint was lower than that of the contralateral knee joint.Knee ROM difference was smaller[(-3.48±0.97)° vs.(-7.36±1.01)°](P<0.05).At 12 months postoperatively,the Rasmussen radiological score[(14.79±3.17)vs.(12.24±4.25)]was higher in the ARIF group than that in the ORIF group(P<0.05).ARIF group had lower ADD[(1.37±1.31)mm vs.(2.13±1.33)mm]at 6 months and at 12 months[(2.12±1.12)mm vs.(2.71±1.25)mm]postoperatively than that in the ORIF group(P<0.05).Conclusions Both ARIF and ORIF provide satisfactory results in treating patients with posterior posterolateral tibial plateau fractures,but ARIF has better reduction and functional recovery.ARIF is recommended for the routine treatment ofposterior lateral tibial plateau fractures.
万方数据
维普
