膝关节前交叉韧带撕脱骨折最佳入路的实验研究  

Optimal Surgical Approach for Intercondylar Eminence Avulsion Fracture

作　　者：蔡俊丰[1] 王予彬[2] 祝建光[1] 李国风[1] 尹峰[1] 袁锋[1] 

机构地区：[1]同济大学附属东方医院骨科,上海200120 [2]同济大学附属东方医院运动医学科,上海200120

出　　处：《中国微创外科杂志》2010年第5期431-434,共4页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨关节镜下锚钉固定前交叉韧带(anterior cruciate ligament,ACL)撕脱骨折的最佳入路,指导临床手术操作。方法将6具尸体膝关节标本分别进行实验,使用克氏针为导针,进针点为髌骨内外上缘、髌骨体部中点两侧、髌骨内外下方,止于髁间嵴前部。以胫骨髁间嵴前部的垂直线为测量标准线,在屈曲30°、60°、90°及内旋、中立、外旋位时测定克氏针与标准线的夹角(正位A角、侧位B角),并观察进针有无阻碍。结果膝关节外旋位时髁间嵴前部暴露最充分,屈曲90°时,进针没有明显阻碍。第2、4、6组在外旋位、中立位时A角均远大于第1、3、5组,内旋位时小于1、3、5组(P<0.01),而B角基本相似(P>0.05)。内侧进针时中立位A角远大于外旋位A角(P<0.01)。第3、4、5、6组的B角远大于第1、2组结论膝关节屈曲90°外旋位时髌骨内上方进针是关节镜下锚钉固定ACL撕脱骨折的最佳入路。Objective To discuss the optimal approach for tibial intercondylar eminence avulsion fracture with anchor under arthroscope and the guidance for the clinical use of this approach.Methods Six human cadaveric knees were used for this experimental study.We inserted K-wire from six points around the patella to the anterior part of the intercondylar eminence.According to the puncture sites,totally 6 experiment groups were set（group 1：punctured at the superior medial edge of the patella;group 2：at the superior external edge;group 3：at the median medial edge;group 4：at the median external edge;group 5：at the inferior medial edge;group 6：at the inferior external edge）.The vertical line of the tibia plateau was employed as a standard line,so that we could measure the angles（angles A and B）between the K-wire and the standard line in different positions of the knee joint（flexion at 30°,60°,and 90°,and internal and external rotation,as well as neutral position）and observe weather the insertion was hindered or not.Results The anterior part of the intercondylar eminence was exposed sufficiently when the joint was put at external rotation,and the insertion was not hindered when the knee was flexed at 90°.The A angles in groups 2,4,and 6 were significantly larger than that in groups 1,3,and 5 at external rotation and neutral positions,but significantly smaller than that in groups 1,3,and 5 at internal rotation（P〈0.01）.In addition,B angles in groups 3-6 were significantly larger than that in groups 1 and 2.ConclusionsPuncture through the superiomedial edge of the patella when the joint bend at 90 degrees with external rotation is the optimal approach for tibial intercondylar eminence avulsion fracture with anchor under arthroscope.

关 键 词：前交叉韧带 髁间嵴撕脱骨折 关节镜 锚钉 

分 类 号：R687.3[医药卫生—骨科学]