关节镜辅助"胫骨隧道技术"结合MIPPO钢板固定治疗胫骨后外侧平台塌陷骨折OA

Objective To compare the clinical outcomes of arthroscopy-assisted"tibial tunnel technique"with MIPPO plating versus conventional open reduction and internal fixation(ORIF)for the treatment of posterolateral tibial plateau collapse fractures.Methods A retrospective analysis was conducted on 65 patients with posterolateral tibial plateau collapse fractures treated at the Second Affiliated Hospital of Xi'an Jiaotong University between August 2022 and August 2024.Thirty-two patients were treated with arthroscopy-assisted"tibial tunnel technique"and minimally invasive percutaneous plate osteosynthesis(MIPPO)plating(arthroscopy group),while 33 underwent conventional open reduction and internal fixation(open reduction group).Operative time,incision length,blood loss,intraoperative fluoroscopy frequency,hospital stay,and postoperative complications were compared between the two groups.At the 1-year follow-up,fracture healing was assessed radiographically.Knee range of motion(ROM),Rasmussen radiological score,visual analog scale(VAS)for pain,Hospital for Special Surgery(HSS)knee score,and Tegner activity level score were also compared.Results No significant differences were observed in baseline characteristics between the two groups preoperatively(P>0.05).All patients were followed up completely,with a mean follow-up of 13.25 months(ranges:12-15 months).All wounds achieved primary healing without infection or neurovascular injury.Operative time was similar between the arthroscopy group[(56.53±4.31)min]and the open reduction group[(54.66±5.25)min](P>0.05).However,the arthroscopy group demonstrated a significantly shorter incision length[(5.42±1.33)cm vs.(8.58±3.25)cm],less intraoperative blood loss[(50.85±8.62)mL vs.(84.27±5.53)mL],and fewer intraoperative fluoroscopies[(4.52±1.21)times vs.(8.45±2.16)times]compared to the open reduction group(all P<0.05).Hospital stay showed no significant difference[(5.83±0.61)d vs.(6.26±1.17)d](P>0.05).There was no statistically significant difference in the Rasmussen score of the two groups at 2 days after operation.At the 1-year follow-up,radiographic evaluation confirmed fracture union in all patients.No significant differences were found between the two groups in knee ROM,VAS pain score,Tegner score,excellent/good rate on the HSS score,(all P>0.05).Conclusion The arthroscopy-assisted"tibial tunnel technique"combined with MIPPO plating offers clinical efficacy comparable to conventional open reduction and internal fixation for posterolateral tibial plateau collapse fractures.However,the arthroscopic technique is associated with less surgical trauma,reduced blood loss,and decreased radiation exposure,making it a technique worthy of clinical promotion.