关节镜下胫骨髁间棘骨折的治疗  

Arthroscopic treatment of tibial eminence fractures

作　　者：刘云鹏[1] 杨柳[1] 陈光兴[1] 郭林[1] 唐康来[1] 戴刚[1] 

机构地区：[1]第三军医大学附属西南医院关节外科中心,重庆400038

出　　处：《中华创伤骨科杂志》2006年第4期330-333,共4页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨关节镜辅助下胫骨髁间棘骨折的微创治疗。方法对2001年1月～2005年1月期间收治的34例胫骨髁间棘骨折患者的病例资料进行回顾性分析。成人骨折22例,儿童骨折12例。新鲜骨折24例,陈旧性骨折10例。按Meyers-McKeever-Zaricznyj骨折分型:Ⅰ型1例,Ⅱ型9例,Ⅲ型21例,Ⅳ型3例。20例成人骨折患者行单枚空心拉力螺钉固定,12例儿童骨折及1例成人Ⅳ型骨折患者行克氏针固定,1例成人Ⅳ型骨折伴前交叉韧带(ACL)完全损伤患者行韧带重建。术后鼓励患者主动伸屈关节,进行股四头肌、绳肌等长收缩锻炼及髌骨推移锻炼。采用Lysholm膝关节功能评分标准来评定疗效。结果所有患者获10～36个月(平均18个月)随访。成人平均骨愈合时间为7周,儿童为5周。所有患者术后3个月Lysholm膝关节功能评分平均为(91.7±2.3)分,术后6个月评分平均为(94.4±2.8)分,所有患膝恢复健侧活动度。结论关节镜下治疗胫骨髁间棘骨折具有手术创伤小、操作简便、固定可靠、术后康复快、并发症少等优点,同时可以发现并治疗关节内合并伤。Objective To investigate the minimally invasive arthroscopic treatment of tibial eminence fractures. Methods From January 2001 to January 2005, 34 cases of tibial eminence fractures were treated in our department. Their clinic data were analyzed retrospectively. Twenty-two cases were adults and 12 cases children. There were 24 fresh fractures and 10 old ones. According to Meyers-McKeever-Zaricznyj classification systems, there were one case of type Ⅰ, nine cases of type Ⅱ, 21 cases of type Ⅲ, and three cases of type Ⅳ. Twenty adult fractures were fixated by one cannulated lag screw, while 12 children cases and one adult type Ⅳ fracture by the Kirschner wire. One adult case of type Ⅳ fracture combined with anterior cruciate ligament （ACL） injury underwent reconstruction with bone-patellar tendon-bone （B-PT-B） allograft. Patients were encouraged to do postoperative rehabilitation, such as active joint extension and flexion, exercise of isometric contraction of quadriceps femoris and hamstring and patellar movement. The treatment resuhs were evaluated according to Lysholm knee score system. Results All the cases were followed up for 10 to 36 months （mean, 18 months）. The average bone-heeling time for adult was seven weeks, and that for children five weeks. At three months postoperatively, no knee laxity or instability was detected in all the cases, and the affected knees regained full range of motion. The average Lysholm knee score was 91.7 ±2.3 three months after operation, and 94.4 ±2.8 six months after operation. The Lachman test and anterior drawer test （ADT） were both negative. Conclusions The arthroscopic treatment of tibial eminence fracture is easy and minimally invasive, and can lead to reliable reduction and fixation, early mobilization, fewer complications, and quick recovery. Besides it can also diagnose and treat possibly combined intraarticular lesions.

关 键 词：胫骨髁间棘骨折 关节镜 微创 

分 类 号：R687.3[医药卫生—骨科学]