关节镜下治疗胫骨髁间棘撕脱骨折  

Arthroscopic treatment of avulsion fracture of the tibial intercondylar eminence

作　　者：洪雷[1] 冯华[1] 张辉[1] 荣国威[1] 

机构地区：[1]北京积水潭医院运动医学中心,100035

出　　处：《中华骨科杂志》2006年第8期513-516,共4页Chinese Journal of Orthopaedics

摘　　要：目的介绍胫骨髁间棘撕脱骨折在关节镜下复位、空心钉固定的治疗方法。方法2003年2月至2005年9月,共治疗40例胫骨髁间棘撕脱骨折,均为急性损伤。男24例,女16例;平均年龄29.5岁(11～58岁)。其中运动伤21例(52.5%),交通伤14例(35.0%),日常生活伤5例(12.5%)。依据Meyers&McKeever和Zaricznyj分型标准,40例骨折中,Ⅱ型4例(10%),Ⅲ型24例(60%),Ⅳ型12例(30%)。手术完全采用关节镜下技术:首先清除关节腔内积血和凝血块,然后清理骨折端,骨折复位后通过髌骨内上缘入路打入2～3枚导针暂时固定,术中摄X线片示骨折复位理想后,沿导针拧入1～2枚空心钉固定。结果术后平均随访时间20.1个月(6～37个月)。除1例外,骨折均完全愈合。Lachman试验均为阴性;KT-1000测量胫骨最大前移,与健侧差值平均为0.625mm($1～2mm);Lysholm评分平均98.3分(87～100分)。关节活动度正常者34例,屈膝活动受限者5例,但均<10°。1例患者术后膝关节伸屈范围0°-30°-45°,关节镜下行二次膝关节松解手术,术后膝关节伸屈范围0°-10°-80°。8例患者存在轻度膝前疼痛。4例骨骺未闭合的年轻患者,均在术后10～12周时取出内固定空心钉,末次随访时骨折均完全愈合,未发现骨骼发育异常。结论关节镜下空心钉固定胫骨髁间棘骨折是一种简单、安全及有效的方法,同时适用于儿童和成人患者。Objective To describe the arthroscopic reductions and fixation of tibial intercondylar eminence fracture with cannulated screws. Methods During February 2003 to September 2005, 40 patients were treated arthroscopically for fracture of the tibial intercondylar eminence. The average age was 29.5 years （11-58 years）, with a mean follow-up time of 20.1 months（6-37 months）. Among the 40 patients, there were 4 type Ⅱ fractures （10%）, 24 type Ⅲ fractures （60%） and 12 type Ⅳ fractures （30%）. The fragments were reduced and fixed with cannulated screws. All-arthroscopic technique was adopted in all cases. The hematoma and the fragment were debrided, and the bony fragment was reduced and temporarily fixed with 2-3 guide wires through the portal superomedial to the patella. Intra-operative X-ray was taken to prove the reduction. One or two cannulated screws were used to fix the fragment as the definite fixation. Results The fracture healed completely in all but 1 patient. Lachman test were negative in all patients postoperatively. The average postoperative KT-1000 manual maximum displacement （MMD） was 0.625 mm （-1-2 ram） and average Lysholm score was 98.3 points （87-100 points）. The range of motion was normal in 34 patients. Flexion deficit was found in 5 cases, but within 10°. Knee joint stiffness was found in 1 case with range of extension and flexion 0°-300-45°. A secondary operation with arthroscopic release was performed. The range of extension and flexion was improved to 0°-10°-80° postoperatively. Mild anterior knee pains were found in 8 patients. For 4 young patients with open epiphysis, the cannulated screws were removed 10-12 weeks post operation. No growth disturbance was detected for these 4 patients at final follow-up. Conclusion Arthroscopic fixation of fracture of the tibial intercondylar eminence with cannulated screw is a simple, safe and effective procedure suitable for both children and adult patients.

关 键 词：胫骨骨折 关节镜检查 前交叉韧带 

分 类 号：R687.3[医药卫生—骨科学]