摘要
目的探究关节镜下辅助治疗对胫骨平台骨折合并膝关节多韧带损伤患者的疗效。方法收集2022年1月至2024年1月湖北省天门市第一人民医院骨科收治胫骨平台骨折(TPF)合并膝关节多韧带损伤患者96例病例资料。采用单盲法随机将其分为关节镜组(膝关节镜辅助切开复位内固定术)和传统组(传统切开复位内固定术),各48例。两组均给予韧带修复术,并针对不同的Schatzker分型选择不同的固定方式。观察2组手术指标、神经肽Y(NPY)、P物质(SP)、白细胞介素-1β(IL-1β)、肿瘤坏死因子-α(TNF-α)、降钙素(CT)、骨特异性碱性磷酸酶(BAP)和骨形态发生蛋白(BMP)、膝关节活动度、Lysholm膝关节评分、临床疗效。结果关节镜组出血量、切口长度、手术时间、下床时间均低于传统组(P<0.05)。术后1周,关节镜组疼痛应激NPY、SP、IL-1β、TNF-α水平均低于传统组(P<0.05);关节镜组骨生化指标CT、NBAP、BMP水平高于传统组(P<0.05);关节镜组屈膝最大角度和伸膝最大角度高于传统组(P<0.05)。术后6个月,关节镜组Lysholm膝关节评分高于传统组(P<0.05)。术后,关节镜组总有效率为97.9%(47/48)高于传统组总有效率的83.3%(40/48)(P<0.05)。结论采用关节镜下辅助治疗可有效改善胫骨平台骨折合并膝关节多韧带损伤患者的各手术指标和骨代谢指标,降低疼痛应激指标,促进膝关节功能恢复。关节镜下辅助处理骨折优势大于切开复位固定骨折。
Objective To investigate the efficacy of arthroscopic therapy for tibial plateau fracture(TPF)combined with multiple ligament injuries of the knee joint.Methods Ninety-six patients with TPF combined with multiple ligament injuries of the knee admitted to Department of Orthopedics,The First People's Hospital of Tianmen in Hubei Province from January 2022 to January 2024.They were divided into the arthroscopic group(knee arthroscopy-assisted incision-replacement internal fixation)and the traditional group(traditional incision-replacement internal fixation)by randomized single-blind method,with 48 cases each.Both groups were given ligament repair,as well as different fixation methods for different Schatzker type.The surgical indexes,neuropeptide Y(NPY),substance P(SP),interleukin-1β(IL-1β),tumor necrosis factor-α(TNF-α),calcitonin(CT),bone-specific alkaline phosphatase(BAP),and bone morphogenetic protein(BMP),knee mobility,Lysholm knee score,and the clinical outcomes were observed in the 2 groups.Results Bleeding,incision length,operation time,and time out of bed were lower in the arthroscopic group than in the traditional group(P<0.05);at 1 week postoperatively,the levels of pain stress NPY,SP,IL-1β,and TNF-α in the arthroscopic group were lower than those in the traditional group(P<0.05).1 week postoperatively,the levels of bone biochemical indexes CT,BAP,and BMP in the arthroscopic group were higher than those in the traditional group(P<0.05);the maximum angle of knee flexion and maximum angle of knee extension in the arthroscopic group was higher than that in the traditional group(P<0.05),and the Lysholm knee score in the arthroscopic group was higher than that in the traditional group at 6 months after surgery(P<0.05);after surgery,the total effective rate of the arthroscopic group was 97.9%(47/48)higher than that of the traditional group,which was 83.3%(40/48)(P<0.05).Conclusion The use of arthroscopic adjuvant treatment can effectively improve the various surgical indexes and bone metabolism indexes,reduce the pain stress indexes,and promote the functional recovery of the knee joint in patients with tibial plateau fracture combined with multiple ligament injuries of the knee.It suggests that the advantage of arthroscopically assisted management for fractures is greater than that of incisional reduction and fixation of fractures.
作者
石磊
陈骏峰
朱辉
Shi Lei;Chen Junfeng;Zhu Hui(Department of Orthopedics,The First People's Hospital of Tianmen in Hubei Province,Tianmen 431700,China;不详)
出处
《骨科临床与研究杂志》
2025年第2期82-88,共7页
Journal Of Clinical Orthopedics And Research
基金
湖北省教育厅科学技术研究计划优秀中青年人才项目(Q2022404)。
关键词
关节镜
胫骨骨折
膝关节
疗效
Arthroscopes
Tibial fractures
Knee joint
Efficacy
