Abstract:

Objective

To compare the therapeutic effect of knee arthroscope-assisted surgery and conventional surgery on patients with tibial plateau fractures (TPF).

Methods

Clinical data of patients with TPF in department of orthopedics of the First People’ s Hospital of Liangshan Yi Autonomous Prefecture from September 2020 to March 2023 were retrospectively analyzed.TPF patients age over 18 years who were diagnosed as Schatzker type I to III fractures by X-ray examination were included, and the patients with open fractures, comminuted complex fractures, surgical contraindications, concurrent severe soft tissue and nerve injuries or mental disorders were excluded.According to different treatment methods, the patients were divided into open reduction and internal fixation (ORIF) group and arthroscopically assisted reduction and internal fixation (ARIF) group.The propensity score matching method was used to exclude the confounding bias caused by the differences in baseline data between the two groups, and 44 patients were included in each group, but one patient in ORIF group was not included in the study due to the lack of follow-up data.Finally, there were 43 cases in ORIF group and 44 cases in ARIF group.Perioperative indicators of the two groups were compared by paired sample t test, and Hospital for Special Surgery (HSS) knee scores, joint range of motion (knee extension and flexion angles) were compared between groups at six months after surgery, and chi square method was used to compare the excellent and good rate of knee treatment and complications within six months after surgery.

Results

The surgical incision length［(6.0±1.2) cm vs (8.3±1.6) cm］, surgical time［(81.3±14.9) min vs(94.3±18.3) min］, length of hospital stay ［(9.4±3.1) d vs (12.5±3.9) d］, fracture healing time ［(8.3±1.0)weeks vs (9.8±1.3) weeks］ and postoperative drainage volume ［(108.1±18.4) ml vs (135.6±22.4) ml］ all showed better results in ARIF group than in ORIF group (t=7.550, 3.637, 4.224, 6.062, 6.266, all P<0.05).The HSS scores in ARIF group at six months after surgery were higher than those in ORIF group (t=2.540, 4.187,3.235, 4.761, 2.695, 5.743, all P<0.05).At six months after surgery, the knee extension and flexion angles in ARIF group were larger than those in ORIF group (t=6.844, 6.890, both P<0.05).The excellent and good rate of knee function in ARIF group was 90.9%, which was significantly higher than 72.1% in ORIF group(χ²=5.130, P<0.05).Six months after surgery, the total incidence rate of complications such as postoperative infection, knee stiffness and knee pain was 4.5% in ARIF group, which was lower than 18.6% in ORIF group(χ²=4.225, P<0.05).

Conclusion

Knee arthroscope-assisted surgery in treating TPF can shorten length of the hospital stay, promote the early rehabilitation, and improve the knee function and joint range of motion with few postoperative complications and is worthy of clinical application.

Key words: Arthroscope, Orthopedic procedures, Tibial plateau fractures, Fracture fixation,internal