关节镜下前交叉韧带定位器辅助治疗与传统切开内固定治疗胫骨平台骨折的疗效比较分析

Comparative Analysis of the Efficacy of Arthroscopic-Assisted Anterior Cruciate Ligament Locator Treatment versus Traditional Open Reduction and Internal Fixation for Tibial Plateau Fractures

摘要: 目的：本研究旨在比较膝关节镜下采用前交叉韧带定位器精准定位复位内固定与传统切开复位内固定治疗Schatzker II~V型胫骨平台骨折的效果。方法：我们前瞻性地选择了2021年6月至2024年6月在青岛市市立医院接受手术治疗的60例Schatzker II~V型胫骨平台骨折患者，将其随机分为实验组和对照组，每组30例。实验组采用膝关节镜下复位内固定(arthroscopic reduction and internal fixation, ARIF)，通过前交叉韧带定位器定位开窗复位治疗；对照组则进行常规切开复位内固定术(open reduction and internal fixation, ORIF)。比较两组围手术期的情况、膝关节功能恢复及并发症发生等方面的情况。结果：两组患者均完成术后6~12个月的随访，平均随访时间为(10.1 ± 3.6)个月。实验组的手术时间、下床活动时间、住院时间、切口愈合时间和骨折愈合时间均显著短于对照组，差异具有统计学意义(P < 0.05)。实验组的术中失血量和术中透视次数较对照组减少，差异具有统计学意义(P < 0.05)。实验组的切口长度也较对照组短，具有统计学意义(P < 0.05)。术后6个月，实验组的伸膝和屈膝活动度均明显优于对照组，差异具有统计学意义(P < 0.05)。实验组在术后1、3、6个月的膝关节疼痛VAS评分均较对照组低，差异具有统计学意义(P < 0.05)。实验组在术后6个月采用Rasmussen胫骨解部骨折复位解剖学评分和Rasmussen胫骨髁部骨折膝关节功能评分的优良率也较对照组高，差异具有统计学意义(P < 0.05)。实验组的切口感染、切口愈合不良和创伤性关节炎的发生率均低于对照组，差异具有统计学意义(P < 0.05)，而关节僵直的发生率两组无明显统计学意义(P > 0.05)。结论：关节镜下通过前交叉韧带定位器精准定位开窗复位内固定治疗胫骨平台骨折的临床效果明显优于传统的开放复位内固定治疗方式。这种方法具有创伤小、复位和固定精准、关节功能恢复良好、并发症少等优点，值得在临床中推广应用。

Abstract: Objective: This study aims to compare the treatment outcomes involving precise positioning, reduction, and internal fixation using an anterior cruciate ligament locator under knee arthroscopy with traditional open reduction and internal fixation for the management of Schatzker II~V fractures of the tibial plateau. Methods: Between June 2021 and June 2024, 60 patients with Schatzker II~V tibial plateau fractures who underwent surgical treatment at Qingdao Municipal Hospital were randomly allocated to the experimental and control groups, each consisting of 30 patients. The experimental group received arthroscopic reduction and internal fixation (ARIF) with anterior cruciate ligament locator-assisted window reduction, while the control group underwent conventional open reduction and internal fixation (ORIF). Perioperative conditions, recovery of knee joint function, and complications were compared between the two groups. Results: All patients in both groups were followed up for 6~12 months, with an average follow-up period of (10.1 ± 3.6) months. The operation time, time to resume activity, hospitalization duration, incision healing time, and fracture healing time in the experimental group were significantly shorter than those in the control group, and the differences were statistically significant (P < 0.05). The amount of bleeding and the number of fluoroscopy procedures in the experimental group were significantly lower than those in the control group, and the differences were statistically significant (P < 0.05). The incision length in the experimental group was shorter than that in the control group, and the difference was statistically significant (P < 0.05). At six months post-operation, knee flexion and extension activity in the experimental group were significantly higher than those in the control group, and the difference was statistically significant (P < 0.05). At 1-, 3-, and 6-month post-operation, the VAS score for knee pain in the experimental group was significantly lower than that in the control group, and the difference was statistically significant (P < 0.05). Six months post-operation, the excellent and good rates of Rasmussen’s anatomical score for tibial fracture reduction and Rasmussen’s knee joint function score for tibial condylar fracture in the experimental group were significantly higher than those in the control group, and the differences were statistically significant (P < 0.05). The incidence of wound infection, poor wound healing, and traumatic arthritis in the experimental group was significantly lower than that in the control group, and the difference was statistically significant (P < 0.05). However, the difference was not statistically significant in the incidence of joint stiffness between the two groups (P > 0.05). Conclusion: The clinical efficacy of arthroscopic anterior cruciate ligament locator-assisted window reduction and internal fixation is significantly superior to that of traditional open reduction and internal fixation. This method offers the advantages of minimal trauma, precise reduction and fixation, good recovery of joint function, and fewer complications, which is worthy of popularization and application in the clinic.