膝关节镜下手术治疗胫骨平台骨折.doc

膝关节镜下手术治疗胫骨平台骨折[摘要] 目的：探讨膝关节镜下处理胫骨平台骨折的疗效与特点。方法：本组患者33例，合并半月板游离缘破裂10例，前交叉韧带胫侧止点撕脱骨折3例，内侧副韧带完全断裂3例。根据骨与软组织损伤情况，将膝关节镜检查治疗技术与传统手术结合进行处理。结果：术后平均随访2年4个月，根据国际HSS膝功能判定的标准评定疗效，其优良率为93.9%，无明显并发症。结论：关节镜监视与协助下微创治疗平台骨折，具有创伤小、复位直观、固定可靠等优点，不仅适用于SchatzkerⅠ～Ⅲ骨折，对于Ⅳ～Ⅵ骨折也可取得良好疗效果。 [关键词] 关节镜；胫骨平台；骨折 [中图分类号] R683.42[文献标识码]C [文章编号]1673-7210（2009）05（c）-030－０3 Arthroscopic treatment of tibial plateau fracture LI Jun (Orthopaedic Hospital of Shenyang City, Liaoning Province, Shenyang110042,China) [Abstract] Objective: To investigate the therapeutic effect and feature of arthroscopy of knee joint in the treatment of the fracture of tibial plateau. Methods: Among 33 cases involved in this study, there were 10 cases complicated with rupture of menisci freemargin, 3 cases complicated with avulsion fracture of the lateral insertion of anterior cruciate ligament, 3 cases complicated with completely medial collateral ligaments rupture. According to the situation of the injured bone and cartilage, the fracture was dealt with the technique of arthroscope of knee joint combined with the traditional operation. Results: The follow-up lasted for average 32 months, which showed that 93.8% of patients achieved good or excellent functional evaluation according to the international HSS knee score. Conclusion: Less trauma, satisfactory bone reduction and reliable fixation are the virtues of arthroscopic technique in the treatment of tibial plateau fracture. This methods can be used not only for SchatzkerⅠ-Ⅲ type fracture but also for Ⅳ-Ⅵ type fracture, with the same and wonderful effects. [Key words] Arthroscope; Tibial plateau; Bone fracture 胫骨平台骨折属下肢负重关节的关节内骨折，同时可伴有半月板、韧带等损伤，处理不当或遗漏，易引起创伤退变性关节炎等。随着现代骨科的发展，胫骨平台骨折的治疗概念不断更新，从坚强的内固定转变到生物学固定，除了注重骨折的治疗，也注意关节韧带、半月板等组织的保护和治疗。有限切开、直接或间接复位、生物学固定是目前胫骨平台骨折的治疗方向[1]。随着关节镜技术的日益成熟及普及，越来越多的外科医生尝试在关节镜下治疗胫骨平台骨折。其创伤小、复位准确、恢复快等优点也为广大外科医生所认可。2005年3月～2008年4月，我院将膝关节镜检查治疗技术与传统手术方法结合治疗该类骨折，随访33例，现将情况报道如下： 1资料与方法 1.1一般资料 本组患者33例，男19例，女14例；年龄18～54岁，平