标题：膝关节镜下有限切开骨折复位内固定术治疗胫骨平台骨折的疗效及其对患者血清NGF、sVCAM和ALP水平的影响

      作者：何鹏，马拓，杜俊伟，王斌，石海浪    西电集团医院骨科，陕西 西安 710077

      卷次： 2022年33卷5期

      【摘要】 目的 研究膝关节镜下有限切开骨折复位内固定术治疗胫骨平台骨折的疗效及对患者血清神经生长因子(NGF)、血管细胞黏附因子(sVCAM)、碱性磷酸酶(ALP)水平的影响。方法 选择2019年2月至2020年2月西电集团医院骨科收治的60例胫骨平台骨折患者进行研究。按照简单抽签法分为研究组和对照组各30例，对照组患者采用传统切开复位内固定术治疗，研究组患者采用膝关节镜下有限切开骨折复位内固定术治疗。比较两组患者治疗3个月后的治疗优良率、术后恢复情况(手术切口长度、骨折愈合时间、关节活动度)，治疗前及治疗3个月后的膝关节功能评分(Rasmussen)和视觉模拟评分法(VAS)评分、血清NGF、sVCAM和ALP水平，记录两组患者住院期间的并发症发生情况。结果 研究组患者的治疗优良率为86.67%，明显高于对照组的60.00%，差异有统计学意义(P<0.05)；研究组患者的切口长度、手术时间、术中出血量、术后引流量、下床时间分别为(7.85±1.40) cm、(81.90±8.46) min、(78.60±16.21) mL、(31.29±3.28) d、(3.67±0.85) d，明显短于或少于对照组的(15.60±3.91) cm、(107.56±11.87) min、(96.30±19.32) mL、(41.89±6.23) d、(5.18±1.20) d，差异均有统计学意义(P<0.05)；研究组患者的骨折愈合时间为(3.10±0.52)个月，明显短于对照组的(5.89±0.71)个月，关节活动度为(126.75±15.62)°，明显高于对照组的(118.63±13.29)°，差异均有统计学意义(P<0.05)；研究组患者的Rasmussen评分为(25.03±3.87)分，明显高于对照组的(21.65±3.32)分，VAS评分为(3.09±0.52)分，明显低于对照组的(5.61±1.03)分，差异均具有统计学意义(P<0.05)；研究组患者的NGF、ALP水平分别为(1.36±0.32) mg/L、(275.86±60.32) U/L，明显高于对照组的(0.89±0.27) mg/L、(190.76±47.69) U/L，差异均有统计学意义(P<0.05)；研究组患者术后并发症发生率为 3.33%，明显低于对照组的23.33%，差异有统计学意义(P<0.05)。结论 膝关节镜下有限切开骨折复位内固定术治疗胫骨平台骨折可促进患者的骨愈合，减轻炎症因子NGF、sVCAM、ALP水平，减少术后并发症，临床治疗效果显著。
      【关键词】 胫骨平台骨折；膝关节镜；有限切开骨折复位内固定术；炎症反应；并发症
      【中图分类号】 R683.42 【文献标识码】 A 【文章编号】 1003—6350（2022）05—0574—04

Efficacy of limited open reduction and internal fixation under arthroscopy in the treatment of tibial plateaufracture and its effect on patients' serum levels of nerve growth factor, soluble vascular cell adhesion moleculeand alkaline phosphatase.
HE Peng, MA Tuo, DU Jun-wei, WANG Bin, SHI Hai-lang. Department of Orthopedics, XDGroup Hospital, Xi'an 710077, Shaanxi, CHINA
【Abstract】 Objective To study the effect of limited open reduction and internal fixation under arthroscopy inthe treatment of tibial plateau fracture and its effect on the serum levels of nerve growth factor (NGF), soluble vascular celladhesion molecule (sVCAM), and alkaline phosphatase (ALP). Methods Sixty patients with tibial plateau fractures wereselected for this study, who received treatment in the Department of Orthopedics at XD Group Hospital from February2019 to February 2020. According to the simple drawing method, they were divided into a study group and a controlgroup, with 30 cases in each group. The control group was treated with traditional open reduction and internal fixation, andthe study group was treated with limited open reduction and internal fixation under arthroscopy. The excellent and goodrate, and postoperative recovery (incision length, fracture healing time, joint activity) after 3 months of treatment werecompared between the two groups, as well as the Rasmussen Knee score, the Visual Analogue Scale (VAS) scores, andthe serum levels of NGF, sVCAM, and ALP before treatment and after 3 months of treatment. The incidence of complica-tions in the two groups were recorded during the hospitalization. Results The excellent and good rate of treatment inthe study group was 86.67%, which was significantly higher than 60.00% in the control group (P<0.05). The incisionlength, operation time, intraoperative bleeding volume, postoperative drainage volume, and time to get out of bed weresignificantly shorter or less in the study group than in the control group, i.e., incision length (7.85±1.40) cm vs (15.60±3.91) cm; operation time (81.90±8.46) min vs (107.56±11.87) min; intraoperative bleeding volume (78.60±16.21) mL vs(96.30±19.32) mL; postoperative drainage volume (31.29±3.28) d vs (41.89±6.23) d; time out of bed (3.67±0.85) d vs(5.18±1.20) d; all differences were statistically significant (P<0.05). The fracture healing time in the study group was