Clinical research of arthroscopy with minimally invasive percutaneous plate osteossynesis for low energy tibial plateau fracture with ligament injury

OBJECTIVE: To compare clinical effects of minimally invasive percutaneous plate osteosynthesis(MIPPO) and open reduction and internal fixation under arthroscopy for the treatment of low energy tibial plateau fracture with ligament injury. METHODS: From March 2016 to March 2017, 60 tibial plateau fracture patients with ligament injury were divided into A and B groups according to random number table. In group A, there were 30 patients including 14 males and 16 females aged from 30 to 63 years old with an average of (47.25±5.36) years old; 8 patients were classified type I, 12 patients were typeII and 10 patients type III; treated by MIPPO under arthroscopy. In group B, there were 30 patients including 16 males and 14 females aged from 32 to 60 years old with an average of (43.39±4.62) years old; 10 patients were classified to type I, 11 patients were type I and 9 patients type III; treated by open reduction and internal fixation. Imaging data, length of incision, postoperative volume of drainage, intraoperative blood loss, complications, postoperative activity time and hospital stays were observed and compared. Postoperative HSS score at 18 months was used to compare recovery of knee joint function. RESULTS: Sixty patients were followed up for 12 to 24 months with average of 18 months. There were no statistical differences in tilt angle of the tibial plateau (TPA), posterior angle of tibial plateau (PA) and femoro tibial angle (FTA) between two groups at 3 days and 12 months after operation. There was no significance in width of internal joint apace before operation, while group B(6.59±0.71) mm was bigger than group A (4.25±0.65) mm after operation at 12 months. Two patients in group A occurred complications and 6 patients in group B occurred complications, and had differences between two groups(P<0.05). Length of incision, hospital stays, postoperative volume of drainage, intraoperative blood loss and postoperative activity time in group A were(5.17±1.89) cm, (2.14±0.65) weeks, (30.02±3.15) ml, (62.63±9.58) ml, (3.16±1.87)d, respectively; while in group B were(16.25±3.47) cm, (4.57±1.09) weeks, (63.75±9.84) ml, (145.89±12.61) ml, (7.86±2.14) d, respectively; and had statistical differences between two groups(P<0.05). HSS score in group A (87.68±7.39) was higher than that of in group B(69.42±5.13) at 18 months after operation (P<0.05). CONCLUSIONS: Both of MIPPO and open reduction and internal fixation under arthroscopy for low energy tibial plateau fracture with ligament injury could provide stable fixation. Open reduction and internal fixation has advantages of simple operation, but had seriously-injured, MIPPO has advantages of less trauma, good recovery of joint function, less complications and could deal with ligament and meniscus injury.