关节镜联合G臂微创内固定治疗胫骨平台Schatzker Ⅰ~Ⅲ型骨折的疗效分析

Efficacy Analysis of Arthroscopy Combined with G-Arm Minimally Invasive Internal Fixation for Schatzker Type I~III Tibial Plateau Fractures

摘要: 目的：探讨膝关节镜联合G臂辅助下微创内固定治疗Schatzker I~III型胫骨平台骨折的临床疗效。方法：回顾性分析2022年3月至2025年3月暨南大学附属第一医院潮汕医院骨科收治的68例Schatzker I~III型胫骨平台骨折患者资料。根据手术方式分为关节镜组(n = 34例)和传统切开组(n = 34例)。比较两组切口长度、术中出血量、手术时间、下床活动时间、切口愈合时间、骨折愈合时间、术后住院时间；以疼痛视觉模拟评分(VAS)评估术前及术后1 d、3 d、14 d的疼痛程度；采用Rasmussen放射学评分和HSS功能评分评估术后即刻及术后6个月的膝关节功能与骨折复位情况。结果：关节镜组切口长度、术中出血量、下床活动时间、切口愈合时间、术后住院时间均优于传统切开组，差异有统计学意义(P < 0.05)；骨折愈合时间组间差异无统计学意义(P > 0.05)。两组术前VAS评分差异无统计学意义(P > 0.05)；关节镜组术后1 d、3 d、14 d的VAS评分均低于传统切开组，差异有统计学意义(P < 0.05)。关节镜组术后即刻及术后6个月Rasmussen评分、术后6个月HSS评分均优于传统切开组(P < 0.05)。结论：关节镜联合G臂辅助微创内固定治疗Schatzker I~III型胫骨平台骨折，较传统切开手术具有创伤小、疼痛轻、膝关节功能恢复快的优势，能够实现关节面的精准复位，近期疗效良好，值得推广。

Abstract: Objective: To investigate the clinical efficacy of arthroscopic knee surgery combined with G-arm fluoroscopy-assisted minimally invasive internal fixation in the treatment of Schatzker type I~III tibial plateau fractures. Methods: A retrospective analysis was conducted on the clinical data of 68 patients with Schatzker type I~III tibial plateau fractures admitted to the Department of Orthopedics, Chaoshan Hospital of The First Affiliated Hospital of Jinan University, between March 2022 and March 2025. All patients were divided into the arthroscopy group (n = 34) and the conventional open surgery group (n = 34) according to surgical approaches. The two groups were compared in terms of incision length, intraoperative blood loss, operation duration, time to ambulation, incision healing time, fracture healing time, and postoperative hospital stay. The Visual Analogue Scale (VAS) was used to evaluate the degree of pain before operation and at 1, 3 and 14 days after operation. The Rasmussen radiological score and Hospital for Special Surgery (HSS) knee score were adopted to assess knee joint function and fracture reduction immediately after surgery and at 6 months postoperatively. Results: The arthroscopy group was superior to the conventional open surgery group in incision length, intraoperative blood loss, time to ambulation, incision healing time and postoperative hospital stay, with statistically significant differences (P < 0.05); there was no significant between-group difference in fracture healing time (P > 0.05). No significant difference was found in preoperative VAS scores between the two groups (P > 0.05); the VAS scores of the arthroscopy group at 1, 3 and 14 days after operation were significantly lower than those of the conventional open surgery group (P < 0.05). The arthroscopy group achieved better Rasmussen scores immediately after surgery and at 6 months postoperatively, as well as higher HSS scores at 6 months postoperatively compared with the conventional open surgery group (P < 0.05). Conclusion: For Schatzker type I~III tibial plateau fractures, arthroscopic surgery combined with G-arm fluoroscopy-assisted minimally invasive internal fixation has the advantages of less trauma, milder postoperative pain and faster recovery of knee joint function compared with conventional open surgery. It can achieve accurate reduction of the articular surface with satisfactory short-term clinical efficacy, which is worthy of clinical popularization.