关节镜辅助下胫骨髁间棘撕脱性骨折的手术治疗  

Arthroscopic treatment for avulsion fracture of intercondylar spine of tibia

作　　者：段小军[1] 杨柳[1] 何天佐[2] 唐康来[1] 陈光兴[1] 郭林[1] 

机构地区：[1]第三军医大学西南医院关节外科中心,重庆400038 [2]成都军区八一骨科医院

出　　处：《中国骨伤》2006年第6期338-340,共3页China Journal of Orthopaedics and Traumatology

摘　　要：目的:探讨在关节镜辅助下对胫骨髁间棘撕脱性骨折进行微创治疗的手术方法及近期疗效。方法:自2001年5月-2003年12月,共手术治疗28例胫骨髁间棘骨折,合并半月板损伤9例。术中在关节镜辅助下,首先对合并损伤进行相应处理,然后依靠器械对骨折进行解剖复位,通过克氏针暂时固定,C形臂X线机透视确认后,再选择松质骨螺钉或钢丝固定,最后再次透视检查。术后按程序进行康复锻炼。结果:髁间棘撕脱性骨折发生在前交叉韧带止点处19例,发生在后交叉韧带止点处9例。除三例采用钢丝固定外,其余均采用AO松质骨螺钉固定。全部患者均获随访,平均时间(15±2)个月,骨折在3～4个月骨性愈合,术后无切口愈合不良、感染和骨筋膜室综合征等早期并发症,25例膝关节功能完全正常,3例活动范围0°～100°,根据Rasmussen评分,27例优良,1例可,总评分(27±1)分。结论:在治疗胫骨髁间棘撕脱性骨折时,采用关节镜辅助下的有限切口结合少量固定的手术,具有创伤小、可同时处理关节腔内的其他损伤等优势,可以获得骨折愈合快、膝关节功能良好的近期疗效,值得推广应用。Objective：To explore minimal surgical treatment of avulsion fracture of intercondylar spine of tibia under arthroscope,and to study its corresponding therapeutic effects. Methods. From 2001.5 to 2003. 12,28 patients with avulsion fracture of intercondylar spine of tibia were treated with minimal surgical method, among all the patients 9 patients were accompanied with meniscus injury. Firstly, the combined injuries were treated. Then the dissociative fragments were reduced and fixed. Lastly, the internal fixation was confirmed by X-ray equipment. Postoperative management was carried out step by step according to a routine treatment protocal. Results ： Nineteen patients had bony avulsion at the anterior cruciate ligament, and 9 patients had bony avulsion at the posterior cruciate ligament. Screws were used for fixation in 25 patients and steel wires were used in 3 patients. All the patients were followed up for 15 ± 2 months. Three or four weeks after operation,the fracture healed up without complications such as wound disunion, infection and osteofascial compartment syndrome. The knee function recovered to normal in 25 patients, and 3 patients had knee joint movement ranging from zero to 100 degree after operation. According to Rasmussen＇s scoring system,27 patients reached excellent result, 1 good, and the mean score was 27 ± 1 in all patients. Conclusion：Arthroscopic treatment is a good choice for avulsion fracture of intercondylar spine of tibia. The advantages of this method are minimal invasive,simple procedure, less time for operation and hospitalization with early rehabilitation, as well as all combined injuries can be treated at the same time.

关 键 词：胫骨骨折 外科手术 关节镜 膝损伤 

分 类 号：R683.42[医药卫生—骨科学] R684[医药卫生—外科学]