关键词: 胫骨平台骨折； 关节镜下微创经皮钢板内固定术； 膝关节僵硬； 危险因素

Abstract: Objective To explore the risk factors of knee stiffness after minimally invasive arthroscopic percutaneous plate fixation (MIPPO) for tibial plateau fracture.Methods A retrospective study was conducted on the clinical data of 185 patients who underwent arthroscopic MIPPO treatment for tibial plateau fracture admitted to the Department of Orthopedics of the First Affiliated Hospital of Air Force Medical University from December 2020 to December 2022.The group was categorized according to the occurrence of joint stiffness at 1 year postoperatively into the no joint stiffness group (n=157 cases) and the joint stiffness group (n=28 cases).The relevant data of the two groups before,during and after operation were collected for univariate analysis,and the statistically significant indicators in the analysis were incorporated into binary Logistic regression analysis to analyze whether they were risk factors for knee stiffness after MIPPO arthroscopic treatment of tibial plateau fracture.Results Univariate analysis of preoperative indicators showed that the differences between the two groups were not statistically significant when comparing age,gender,body mass index,smoking history,diabetes mellitus,occupation as a worker,Schatzker typing of fractures,timing of surgery,and high-energy injuries (P>0.05),but there was a statistically significant difference in the comparison of the two groups in the combination of heterotopic ossification and combination of extensor device injuries (P<0.05).One-way analysis of intraoperative indicators showed that the differences between the two groups in the placement of drains,operation time,intraoperative bleeding,and incision length were not statistically significant (P>0.05).Single-factor analysis of postoperative indicators showed that the differences between the two groups were not statistically significant when comparing postoperative analgesia,hospitalization time,incision healing time,lower extremity deep vein thrombosis,and incision infection (P>0.05),but the differences were statistically significant when comparing standardized rehabilitation training (P<0.05).Binary logistic regression analysis showed that the combination of heterotopic ossification,the combination of knee extension device injury,and the lack of standardized rehabilitation training were all risk factors for postoperative knee stiffness in the treatment of tibial plateau fracture by arthroscopic MIPPO (P<0.05).Conclusion Combined heterotopic ossification,combined knee extension device injury,and lack of standardized rehabilitation training are all risk factors for postoperative knee stiffness in arthroscopic MIPPO for tibial plateau fracture,and clinical attention should be paid to patients with these factors.

Key words: tibial plateau fracture; arthroscopic minimally invasive percutaneous plate internal fixation; knee stiffness; risk factors