摘要
目的 探讨关节镜下对前叉韧带胫骨止点撕脱骨折进行缝线栓结固定的手术方法及疗效分析。方法2006年2月至2012年12月,我科对28例前叉韧带胫骨止点撕脱骨折患者在关节镜下行骨折解剖复位缝线固定术,其中男24例,女4例;年龄17-65岁,平均年龄43岁。胫骨止点撕脱骨折按Meyers-McKeever分型为II型7例,III型16例,IV型5例;术前前抽屉试验及Lachman试验均呈阳性,Lysholm评分为（55.3±1.6）分。患者受伤后到入院的时间分别为1-48周,平均为37周。采用关节镜下骨折复位后,在前交叉韧带定位器引导下,经胫骨上段前内侧创建骨隧道,沿骨隧道将2号Ethibond缝线引入关节腔,利用肌腱线紧密打结,将撕脱骨块解剖复位固定。结果 术后切口均Ⅰ期愈合,无感染、皮肤坏死、骨折块松动脱位及下肢深静脉血栓形成等并发症发生。28例均获随访,随访时间12-36个月,平均25.6个月。X线片检查示骨折均达骨性愈合,愈合时间2-4个月,平均3个月。术后12个月复查Lachman试验、前抽屉试验、轴移试验均为阴性。术后12个月膝关节活动度正常者26例,伴有轻度活动受限者2例。术后12个月Lysholm评分为（92.5±2.4）分,与术前比较差异有统计学意（t=42.220,P=0.000）。结论 关节镜下前叉胫骨止点撕脱骨折行缝线固定的手术方法创伤小、固定可靠,有利于实现ACL胫骨止点解剖原点重建,恢复ACL正常生理功能。
Objective To investigate the therapeutic effect of arthroscopic reduction ACL reconstruction for treating tibial intercondylar eminence avulsion fracture using suture anchors. Methods Between February 2006 and December 2012,28 patients with tibial intercondylar eminence avulsion fracture were treated with arthroscopic reduction using suture fixation. According to Meyers-McKeever classification,7 cases of 28 were rated as type Ⅱ,16 as type Ⅲ,and 5 as type Ⅳ fractures. Anterior drawer test and Lachman test of all patients were positive. Lysholm scores were（55. 3 ± 1. 6）,respectively. Assisted with anterior cruciate ligament-aimer,bone tunnels were built through the fracture fragments after fracture reduction,through which Ethibond 2 polyester sutures were guided into the joint by spine needles;after knot of 2 sutures or knot of only 1 suture was made,the other ends of sutures were fastened together outside the joint. Results The incisions of all the cases healed by first intention with no complication of infection or deep venous thrombosis. Twenty-eight patients were followed up 12-36 months with an average of 25. 6 months. The X-ray examination indicated fractures healed in all the cases at 2-4 months（ mean,3 months） . At 12 months after operation, extension and flexion spheres of knee activity were normal in 26 cases and were limited in 2 cases. The Lysholm score was（92. 5 ±2. 4）,showing significant difference when compared with the preoperative score（t=42. 220,P=0. 000）. Conclusion Suture fixation under arthroscope is an effective method with small invasion,reliable fixation,and simple operation for treating tibial intercondylar anterior eminence fracture,and gave a simplicity,and effectiveness for anatomic ACL reconstruction.
出处
《四川医学》
CAS
2014年第9期1150-1152,共3页
Sichuan Medical Journal
关键词
髁间嵴撕脱骨折
前交叉韧带
关节镜技术
tibial intercondylar eminence
avulsion facture
anterior cruciate ligament
arthroscopy
