关节镜应用于经关节骨折的探讨

目的：介绍利用膝关节镜铺助治疗胫骨平台骨折,了解膝关节腔骨结构损伤情况,并行镜下治疗,监视并辅助骨折复位,关节腔外A0髁钢板及松质骨螺钉内固定手术方法及临床疗效.方法：2003年9月～2005年1月,共完成24例手术.关节镜下清除关节内积血及凝血块,检查滑膜、半月板、十字韧带、髁间棘有无损伤,并行镜下治疗,在钝穿刺锥协助下行骨折复位,关节腔外AO胫骨髁钢板及松质骨螺钉内固定,骨缺损同时予以植骨.术后早期功能锻炼.结果：按Merchant评分标准,优18例,良3例,可3例,优良率87.5%.结论：利用关节镜检查治疗胫骨平台骨折后关节腔内损伤结构,监视并辅助骨折复位,关节腔外内固定技术,可最大程度地减少术中创伤,手术方法简便易行,可作为治疗此类骨折的方法.

Arthroscopy-assisted Treatment of Fracture of Tibial Plateau

Objective:To describe an arthroscopy-assisted technique for the treatment of fracture of tibial plateau and investigate operative procedure and clinical effectiveness of arthroscopic reduction and extra-articular fixation using AO condylar steel plate and cancellous screws by diagnostic arthroscopy.Methods:From September 2003 to March 2005,24 patients with fracture of tibial plateau were treated in our department.The reduction of fracture with the help of blunt puncture prick was done after arthroscopic elimination of hemarthrosis was performed and injuries of synovialis,meniscus,cruciate ligament and intercondylar eminence of the tibia were examined.The fracture was fixed using extra-articular AO tibial condylar steel plate and cancellous screws technology,the bone defect was repaired simultaneously using bone graft if it was necessary.Results: Of 24 patients,15 were involved in a longitudinal study follow-up for a mean of 13(9-18)months postoperatively.The excellent and good rate was 87.5% according to Merchant's Grades.Conclusion:Arthroscopy-assisted reduction of fracture of the tibial plateau and internal fixation provide an accurate assessment of intraarticular injuries associated with fracture of tibial plateau,allow less soft tissue trauma than that with traditional arthrotomy,and is a simple and effective treatment for fracture of tibial plateau.