目的：探讨关节镜下微创治疗胫骨平台骨折的疗效观察。方法将2012年1月至2014年12月治疗的55例胫骨平台骨折患者，采用关节镜下微创治疗胫骨平台骨折。其中男31例，女24例；年龄22~70岁，平均33.8岁。手术前患者拍摄X线片、三维CT重建、MRI等，使用不同的切口及方法复位，术中先行关节镜检查，在关节镜下根据骨折通过Schatzker进行分型，复位塌陷的骨折，用胫骨锁定钢板或拉力螺钉固定胫骨平台骨折。结果55例获得随访，随访时间12~24个月，平均14.5个月。骨折临床愈合时间平均4.2个月，术后3个月膝关节活动度平均为115.5°，完全负重时间平均4.8个月。美国特种外科医院（HSS）膝关节评分，优42例、良8例、可5例，无差病例，优良率90.9％。结论经关节镜下微创治疗的胫骨平台骨折，其临床效果好，患者满意度高。采用关节镜下微创治疗胫骨平台骨折的手术方法可以获得满意的复位与良好固定，术中不用切开关节囊，减少了手术创伤及感染的风险，使术后功能较快的恢复；能够清楚的观察关节面及骨折情况，确定手术的入路及内固定方法；术中灌注液持续冲洗，降低了感染的发生率，具有操作简单、愈合快、创伤小、安全等临床治疗优势。%Objective To investigate the effect of minimally invasive treatment of tibial plateau fractures under arthroscope.Methods A total of 55 cases with tibial plateau fractures were treated by minimally invasive treatment under arthroscope from January 2012 to December 2014.Of all, the ages of 31 cases of men and 24 cases of women were 22 yeas old to 70 yeas old(average 33.8 years old). Before surgery patients were examed with X rays,three-dimensional CT reconstruction,MRI,etc.We used different incision and methods to reduce the fracture. During the surgery,we lead arthroscopy first and then,we typed the fractures based on Schatzker criteria and reduce the collapse of fractures,lastly,we used the tibial locking plate or tension screw to fix tibial plateau fractures. Results All the cases were followed up 12 to 24 months(average 14.5 months). The average clinical healing time of fractures was 4.2 months,The average knee joint motion was 115.5°3 months after sugery and the average full weight-bearing time was 4.8 months.According to the HSS score system,42 cases got excellent,8 cases got well.5 cases got average and there were no poor cases, so the excellent and good rate was 90.9%.Conclusions The minimally invasive treatment of tibial plateau fractures under arthroscopy gets good clinical effect and high patient satisfaction. Using minimally invasive treatment of tibial plateau fractures under arthroscopy can obtain satisfactory reduction and good fixation,reduce the risk of surgical trauma and infection without joint capsule incision and make faster recovery of postoperative function. Besides,we can get a clear observation of articular surface and fracture,determine the surgical approach and internal fixation method. Intraoperative continuous perfusate flushing can reduce the incidence of infection. In short,minimally invasive treatment of tibial plateau fractures under arthroscope have clinical advantages of simpler operation,faster healing,less trauma and safer.
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