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中华关节外科杂志(电子版)

中华关节外科杂志(电子版) ›› 2020, Vol. 14 ›› Issue (04) : 495 -499. doi: 10.3877/cma.j.issn.1674-134X.2020.04.018

所属专题： 文献；

临床经验

关节镜辅助复位内固定术治疗膝关节内骨折的疗效
谭希鹏1, 黄建国1,†(), 陈志荣1, 郭浩辉1   
  1. 1. 750004　银川，宁夏医科大学总医院骨三科
  • 收稿日期:2018-12-06 出版日期:2020-08-01
  • 通信作者: 黄建国

Arthroscope assisted reduction and internal fixation in treatment of intra-articular knee fractures

Xipeng Tan1, Jianguo Huang1,†(), Zhirong Chen1, Haohui Guo1   

  1. 1. Department of orthopedics, General Hospital of Ningxia Medical University, Yinchuan 750004, China
  • Received:2018-12-06 Published:2020-08-01
  • Corresponding author: Jianguo Huang
  • About author:
    Corresponding author: Huang Jianguo, Email:
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谭希鹏, 黄建国, 陈志荣, 郭浩辉. 关节镜辅助复位内固定术治疗膝关节内骨折的疗效[J]. 中华关节外科杂志(电子版), 2020, 14(04): 495-499.

Xipeng Tan, Jianguo Huang, Zhirong Chen, Haohui Guo. Arthroscope assisted reduction and internal fixation in treatment of intra-articular knee fractures[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2020, 14(04): 495-499.

目的

探究关节镜辅助复位内固定术治疗膝关节内骨折的短期临床效果。

方法

回顾性分析2017年5月至2018年5月在宁夏医科大学总医院骨三科接受手术治疗的膝关节内骨折患者。共纳入120例，其中行关节镜辅助复位内固定术者纳入观察组，行切开复位内固定术者纳入对照组，每组60例。随访至骨折完全愈合。采用t检验比较2组术中出血量、手术时间、住院时间、骨折愈合时间、术后即刻血清炎症指标、术后1个月的生活质量评分(SF-36评分)、关节活动度(ROM)和美国特种外科医院膝关节评分(HSS)。通过ROM计算优良率，行卡方检验。

结果

优良率观察组为98.3%，对照组为85.0%(χ2＝6.982，P<0.05)。观察组住院时间、手术时间都短于对照组(t＝12.619、23.351，均为P<0.05)，术中出血量少于对照组(t＝11.249，P<0.05)。术后1个月，观察组SF-36评分、ROM、HSS评分均高于对照组(SF-36评分t＝25.10，ROM t＝25.25, HSS评分t＝12.25，均为P<0.05)。两组的术前CRP、IL-6、TNF-α水平对比差异无统计学意义(t＝0.756、1.100、0.702，均为P>0.05)；观察组CRP、IL-6、TNF-α水平低于对照组(t＝4.389、3.828、7.902，均为P <0.05)，观察组的骨折愈合时间短于对照组(t＝11.345，P <0.05)。

结论

关节镜辅助复位内固定术治疗膝关节内骨折效果肯定，且有创伤小，恢复快等优点，临床中可以选择性使用，但需严格把握适应症。

关键词: 关节镜, 膝关节, 骨折, 骨折固定术, 生活质量
Objective

To explore the short-term clinical effect of arthroscopically assisted reduction and internal fixation(ARIF) in the treatment of intra-articular knee fractures.

Methods

From May 2017 to May 2018, the patients with intra-articular knee fractures who undergone surgical treatment in Department of orthopedics, General Hospital of Ningxia Medical University were retrospectively analyzed. One hundred and twenty patients were reviewed. The patients treated by ARIF were in the observation group (n=60), and the patients treated by open reduction and internal fixation (ORIF) were in the control group (n=60). All the patients were followed up until the fractures healed completely. Intraoperative blood loss, operative time, hospitalization time, fracture healing time, postoperative serum inflammatory biomarkers, hospital for special surgery knee score (HSS), range of motion (ROM) and quality of life scores (SF-36 scores) in one month were compared by t test. The good rate was calculated by ROM and was compared by chi-square test.

Results

The good rate was 98.3% in the observation group and 85.0% in the control group (χ2 =6.982, P<0.05). Length of hospital stay and operation time in the observation group were significantly shorter than those in the control group (t=12.619, 23.351, both P<0.05). The intraoperative blood loss was significantly less than that of the control group (t=11.249, P<0.05). One month after surgery, SF-36 scores, ROM and HSS scores of the observation group were significantly higher than those of the control group (SF-36 t=25.10, ROM t=25.25, HSS t=12.25, all P <0.05). There was no significant difference in preoperative C-reactive protein (CRP), interleukin-6 (IL-6) or tumour necrosis factor alpha (TNF-α) levels between the two groups (t=0.756, 1.100, 0.702, all P >0.05). The levels of CRP, IL-6 and TNF-α in the observation group were significantly lower than those in the control group (t=4.389, 3.828 and 7.902, all P <0.05). The fracture healing time of observation group was significantly shorter than that of control group (t=11.345, P <0.05).

Conclusion

Arthroscope assisted reduction and internal fixation in the treatment of intra-articular knee fractures is effective and has the advantages of small trauma and quick recovery, which can be used selectively in clinical practice, but the indications should be strictly controlled.

Key words: Arthroscopes, Knee joint, Fractures, bone, Fracture fixation, Quality of life
表1 两组一般资料比较
分组 例数 年龄[岁，(±s)] 性别(男/女) 骨折部位(例) 受伤原因(例)
髌骨 股骨髁 胫骨髁间嵴 胫骨平台 摔伤 车祸 坠落伤 其他
观察组 60 44±55 34/26 12 31 14 5 11 29 13 7
对照组 60 43±5 33/27 10 30 15 5 12 28 12 8
统计值 t＝0.564 χ2＝0.394 χ2＝0.876 χ2＝0.345
P值 >0.05 >0.05 >0.05 >0.05
表2 两组优良率[例(%)]
组别 例数 优 良 可 差 优良率
对照组 60 21(35.0) 30(50.0) 6(10.0) 3(5.0) 51/60(85.0)
观察组 60 35(58.3) 24(40.0) 1(1.7) 0(0.0) 59/60(98.3)
χ2值 - - - - 6.982
P值 - - - - <0.05
表3 两组住院时间、手术时间、术中出血量、骨折愈合时间比较(±s)
组别 例数 住院时间(d) 手术时间(min) 术中出血量(ml) 骨折愈合时间(月)
观察组 60 6.8±1.8 62.5±6.7 128.9±10.7 2.3±1.3
对照组 60 13.9±3.9 96.3±9.0 163.1±20.9 3.5±1.5
t值 - 12.619 23.351 11.249 11.345
P值 - <0.01 <0.01 <0.01 <0.01
表4 两组SF-36评分、ROM、HSS评分比较(±s)
组别 例数 SF-36评分 ROM(°) HSS评分
术前 术后1个月 术前 术后1个月 术前 术后1个月
观察组 60 68±7 90±3a 67±7 108±6b 56±4 86±6c
对照组 60 67±7 76±3d 68±6 97±6e 57±6 75±4f
t值 0.658 25.1 0.348 25.255 0.921 12.253
P值 >0.05 <0.01 >0.05 <0.01 >0.05 <0.01
表5 血清炎症指标比较(±s)
指标 例数 CRP(mg/L) IL-6(ng/L) TNF-α(ng/L)
术前 术后即刻 术前 术后即刻 术前 术后即刻
观察组 60 26±5 27±4 180±23 186±33 59±6 62±8
对照组 60 26±5 30±4 175±21 211±35 59±6 74±9
t值 0.756 4.389 1.1 3.828 0.702 7.902
P值 >0.05 <0.01 >0.05 <0.01 >0.05 <0.01
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