中国修复重建外科杂志

中国修复重建外科杂志

关节镜下缝合线桥内固定技术治疗青少年前交叉韧带胫骨止点撕脱骨折

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目的 探讨关节镜下采用缝合线桥内固定技术治疗青少年前交叉韧带胫骨止点撕脱骨折的疗效。 方法 2013 年 6 月—2016 年 10 月,收治 18 例前交叉韧带胫骨止点撕脱骨折青少年患者。男 11 例,女 7 例;年龄 5~17 岁,平均 12.5 岁。致伤原因:摔伤 6 例,扭伤 4 例,运动伤 8 例。伤后至就诊时间 2 h~10 个月,中位时间 2 个月。Lachman 征及前抽屉试验均为阳性。膝关节疼痛 10 例,主诉不能伸直 4 例,伸膝无力 4 例。根据 Meyer-McKeever 分型标准,Ⅱ型 12 例,Ⅲ型 6 例。关节镜下,采用单枚外排锚钉结合 Orthocord®高强缝线,运用缝合线桥内固定技术治疗。 结果 术后患者切口均Ⅰ期愈合。18 例患者均获随访,随访时间 10~18 个月,平均 12 个月。X 线片复查示骨折均愈合,愈合时间 6~12 周,平均 8 周。术后 Lachman 试验及前抽屉试验均呈阴性。末次随访时,患侧 Lysholm 评分为(90.1±5.0)分,与健侧(93.1±6.2)分比较,差异无统计学意义(t=0.669,P=3.184【?】)。患者未出现骨骺损伤闭合及患肢短缩畸形。 结论 关节镜下采用缝合线桥内固定技术治疗青少年前交叉韧带胫骨止点撕脱骨折,对骺板损伤小,固定牢靠,骨折愈合好,不需二次手术取出内植物,可获得较好疗效。

Objective To explore effectiveness of suture-bridge fixation under arthroscopy in treatment of tibial eminence avulsion fracture of anterior cruciate ligament in adolescents. Methods Between June 2013 and October 2016, 18 adolescent patients suffered tibial eminence avulsion fracture of anterior cruciate ligament were treated by suture-bridge fixation under arthroscopy. There were 11 males and 7 females with an average age of 12.5 years (range, 5-17 years). The injury caused by bruise in 6 cases, by sprain in 4 cases, and by sport injury in 8 cases. The interval between injury and admission ranged from 2 hours to 10 months (mean, 2 months). The results of preoperative Lachman and anterior drawer tests were positive. There were 10 cases of knee pain, 4 cases of knee extension limitation, and 4 cases of knee extension without strength. According to the Meyer-McKeever classification criteria, 12 cases were type Ⅱ and 6 cases were type Ⅲ. Results All incisions healed by first intention. All 18 patients were followed up 10-18 months after operation, with an average of 12 months. Postoperative X-ray films showed that all fractures healed after 6-12 weeks (mean, 8 weeks). The results of postoperative Lachman and anterior drawer tests were negative. At last follow-up, the Lysholm knee score was 90.1±5.0 and 93.1±6.2 for affected and unaffected sides, respectively, showing no significant difference between affected and unaffected sides(t=0.669, P=3.184[?]). There was no premature closure of skeleton or leg length discrepancy and deformity. Conclusion For tibial eminence avulsion fracture of anterior cruciate ligament in adolescents, the suture-bridge fixation under arthroscopy is an effective method with many advantages, such as minimal invasion, reliable fixation, good fracture healing, and no need for second operation to remove implants.

关键词: 关节镜; 前交叉韧带; 胫骨止点; 撕脱骨折; 缝合线桥内固定技术; 青少年

Key words: Arthroscopy; anterior cruciate ligament; tibial insertion; avulsion fracture; suture-bridge fixation; adolescent

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