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关节镜辅助复位内固定结合加速康复外科与开放复位内固定治疗胫骨平台后外侧骨折的疗效比较

Comparison of the efficacy of arthroscopically-assisted reduction and internal fixation combined with enhanced recovery after surgery and open reduction and internal fixation in the treatment of posterior lateral tibial plateau fractures

    摘要
  • 摘要:
    目的  探讨关节镜辅助复位内固定（arthroscopically-assisted reduction and internal fixation, ARIF）结合加速康复外科（enhanced recovery after surgery, ERAS）理念与开放复位内固定（open reduction and internal fixation, ORIF）治疗胫骨平台后外侧骨折的临床疗效差异。
    方法  回顾性选择2020年1月至2022年11月徐州市中心医院骨科胫骨平台后外侧骨折患者70例，根据治疗方法分为ARIF组（结合ERAS, n＝32）和ORIF组（未结合ERAS, n＝38）。所有患者住院后均通过影像学检查评估骨折类型，比较两组患者的手术时间、住院时间，采用视觉模拟量表（visual analogue scale, VAS）评估患者术后早期疼痛，美国特种外科医院（hospital for special surgery, HSS）评分评估患者术后3个月膝关节功能，比较两组患者术后6个月双侧大腿周径差值。
    结果  ARIF组患者的手术时间显著短于ORIF组（67.84±9.89）min vs（85.16±9.18）min, P＜0.001，住院时间显著短于ORIF组（7.13±1.41）d vs（8.74±1.84）d, P＜0.001。术后第3 天，ARIF组的VAS评分显著低于ORIF组（4.00±1.44）分 vs（5.39±1.24）分, P＜0.001。术后3个月，ARIF组患者的膝关节功能显著优于ORIF组，术后6个月髌骨上10 cm大腿周径差值显著小于ORIF组（P＜0.001）。
    结论 与ORIF相比，接受ARIF结合ERAS治疗胫骨平台后外侧骨折的患者术后恢复更快、住院时间更短、临床疗效更确切。

     

    Abstract:
    Objective  To compare the clinical effects of arthroscopically-assisted reduction and internal fixation (ARIF) combined with enhanced recovery after surgery (ERAS) and open reduction and internal fixation surgery (ORIF) in the treatment of posterior lateral tibial plateau fractures.
    Methods Seventy patients with posterior lateral tibial plateau fractures in the Department of Orthopaedics, Xuzhou Central Hospital, from January 2020 to November 2022 were retrospectively selected and divided into ARIF group (with ERAS, n＝32) and ORIF group (without ERAS, n＝38) according to the treatment methods. All patients were evaluated for fracture type by imaging examination after admission. The operation time, length of hospital stay, early postoperative pain score (evaluated by visual analogue scale VAS), knee joint function (evaluated by hospital for special surgery HSS scale) at 3 months and thigh circumference difference at 6 months postoperatively were compared between the two groups.
    Results The operation time in the ARIF group was significantly shorter than that in the ORIF group (67.84±9.89 min vs 85.16±9.18 min, P＜0.001), and the length of hospital stay was significantly shorter in the ARIF group (7.13±1.41 d vs 8.74±1.84 d, P＜0.001). On the third day after operation, the VAS score in the ARIF group was significantly lower than that in the ORIF group (4.00±1.44 vs 5.39±1.24, P＜0.001). ARIF group had better joint function than ORIF group 3 months after operation, and the difference of 10 cm thigh circumference on patella in ARIF group was smaller than that in ORIF group 6 months after operation.
    Conclusions Compared to ORIF, patients with posterior lateral tibial plateau fractures treated with ARIF combined with ERAS showed faster postoperative recovery, shorter hospital stay, and more precise clinical efficacy.

     

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