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关节镜在胫骨平台骨折诊治中的应用
胫骨平台骨折是下肢负重关节的关节内骨折，约占全身骨折的1%[1]，其主要由交通事故或高处坠落伤等高能量所致，胫骨平台受到外力挤压或撞击时容易造成劈裂或塌陷，产生不同程度的膝内、外翻畸形，严重者还可合并半月板或韧带损伤等周围组织损伤[2]，处理不当常导致膝关节功能恢复不良[3]。传统的切开复位内固定术式严重破坏膝关节周围软组织环境并且不能对骨折伴随损伤妥善处理，由此导致的膝关节并发症经常被报道。近年来关节镜技术快速发展，且已广泛应用于胫骨平台骨折诊疗，关节镜微创技术在胫骨平台骨折治疗中的应用受到越来越多的关注[4]。现就近年来的研究进展综述如下。
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非角度稳定性钢板固定治疗桡骨远端关节内背侧移位骨折的结果
Objective Intra-articular fractures of the distal radius in young adults comprise a distinct fracture pattern that is difficult to manage and associated with a high frequency of post-traumatic arthritis. Restoration of articular congruency and alignment should improve the outcome. Methods In this study we prospectively reviewed the results of 21 consecutive cases of dorsally displaced intra-articular distal radius fractures which were treated with internal fixation after failing to achieve articular congruency with closed reduction. Results 3 patients were lost to follow-up. For the rest of 18 patients, follow-up time ranges from 18 to 75 weeks the fractures had healed with highly satisfactory radiographic and functional results. The final volar tilt averaged 4.9°; radial inclination 23.9°; radial length 14mm; and articular incongruity, 0. 1 mm. Wrist motion at final follow-up examination averaged flexion 62°, extension 60°, radial deviation 16°, ulnar deviation 27°, pronation 77°and supination 74°. Grip strength averaged 83% of the uninjured side. The overall outcome of 18 patients (94.4%) had a good or excellent result according to the system of Gartland and Werley and 18 patients (72. 2% ) had a good result according to the modified system of Green and O'Brien at the most recent evaluation. The only complication in this series was a superficial pin tract infection, which was rapidly resolved with removal of pins at 5th week of external fixation.Conclusion Thus restoration of articular congruency and alignment is possible with minimal complication using modern non-angular stable methods of internal fixation.
