关节镜下手术治疗儿童陈旧性胫骨髁间棘撕脱骨折  

Arthroscopic treatment of nonunited avulsion fractures of the tibial intercondylar eminence in children

作　　者：李强[1] 胡勇[1] 张喜海[2] 杨国勇[3] 陈君蓉[1] 

机构地区：[1]四川省骨科医院运动创伤科,成都610041 [2]泸州医学院附属医院骨科 [3]四川大学华西医院骨科

出　　处：《中华创伤骨科杂志》2008年第1期32-36,共5页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨关节镜下手术治疗儿童陈旧性胫骨髁间棘撕脱骨折的疗效。方法2000年7月～2005年7月治疗16例儿童陈旧性胫骨髁间棘撕脱骨折患者，其中男10例，女6例；根据Meyers ＆ McKeekver及Zaricznyj分型：Ⅱ型9例，Ⅲ型5例，Ⅳ型2例。手术完全采用关节镜下技术：首先清理骨折两端，使用探针撬拨复位骨折块并临时维持复位，通过高位前内入路钻入1枚或数枚克氏针临时固定骨折块，术中X线机透视，骨折复位理想且克氏针未穿过骺板，沿克氏针拧入AO／ASIF中空钛质螺丝钉加垫片固定。结果术后随访6～24个月，平均18．3个月；所有患者骨折均完全愈合，膝关节活动度均正常。Lysholm评分术前为（49．0±11．5）分，术后末次随访时为（90．0±8．6）分，差异有统计学意义（t=1．375，P〈0．05）；IKDC评分术前为（53．3±11．7）分，术后末次随访时为（97．0±3．0）分，差异有统计学意义（t=14．648，P〈0．01）。结论关节镜下使用空心螺钉加垫片不伤及骺板方法固定儿童陈旧性胫骨髁间棘撕脱骨折，安全可靠，治疗效果好。Objective To discuss the arthroscopic reduction and fixation of nonunited avulsion fractures of the tibial insertion of the anterior cruciate ligment （ACL） in children with cannulated screws and clouts. Methods From July 2000 to July 2005, 16 children patients were treated arthroscopically for nonunited avulsion fractures of the tibial ACL insertion. Their average age was 12. 5 yeats （7 to 15）, with a mean follow-up time of 18.3 months （6 to 24）. There were 9 type Ⅱ, 5 type Ⅲ and 2 type Ⅳ fractures. The fragments were reduced and fixed with cannulated screws and clouts. Arthroscopic techniques were adopted in all cases. After the knee debridement, and the bony fragments were reduced and fixed temporarily with one or more guide wires through a higher portal anteriormedial to the patellar tendon. Intra-operative X-ray was taken to ensure that the reduction was fine and the wire had not penetrated the epiphyseal plate. One or more can-nulated screws and clouts were used to fix the fragments along the guide were. Results The fracture healed completely in all patients. The Lechman test was negative in all patients postoperatively except in 2. The knee function was good. The pre- and post-operative Lysholm knee scores were （49. 0±11.5） and （90. 0± 8.6） points respectively （t=1.375, P〈0.05）; the pre-and post-operative IKDC knee scores were （53.3±11.7） and （97.0±3.0） points respectively （t=14.648, P〈0.01）. No growth disturbance was detected in all patients at the final follow-up. Conclusion Arthroscopic fixation of nonunited avulsion fracture of the tibial ACL insertion with cannulated screws and clouts is a simple, safe and effective procedure for children patients.

关 键 词：胫骨 骨折 关节镜 骨折固定术 内 儿童 

分 类 号：R687.3[医药卫生—骨科学]