关节镜下治疗前交叉韧带下止点撕脱骨折16例  

Arthroscopic Treatment of Anterior Cruciate Ligament Tibial Avulsion Fracture in 16 Cases

作　　者：俞胜宝[1] 胡四生[1] 汪炜[1] 凌健[1] 

机构地区：[1]安徽省黄山市人民医院骨科,245000

出　　处：《中华全科医学》2011年第7期1050-1051,共2页Chinese Journal of General Practice

摘　　要：目的观察关节镜下微创治疗前交叉韧带（ACL）胫骨止点撕脱骨折的手术方法及疗效。方法 2007年1月-2010年12月,关节镜下治疗ACL下止点撕脱骨折16例,其中按meyem-meckeever分型1型1例,2型13例,3型2例。常规膝关节髌韧带两侧入路进入关节腔,镜下骨折复位,然后自胫骨结节内侧钻入克氏针,达骨折块,自克氏针孔穿入硬膜外麻醉套管,直径0.5-0.7 mm钢丝导引张力缝线（2号聚乙烯线）经硬膜外麻醉套管穿入固定骨折块。结果术后16例经2-36月随访12周愈合14例,18周愈合2例。优点：关节稳定性好,抽屉试验阴性,功能完全恢复14例,达87.5%;关节稳定性好,抽屉试验（±）,功能恢复良好,2例,占12.5%。结论关节镜下手术具有切口小,操作简单,术后对膝关节副损伤小,内固定牢固等优点,可早期行膝关节功能锻炼以促进膝关节恢复的手术效果,但需掌握较好的关节镜技术。Objective To observe the surgical skill and the clinical outcomes of arthroscopic treatment of anterior cruciate ligament（ACL） tibial avulsion fracture.Methods From January 2007 to December 2010,16 cases of avulsion fracture of intercondylar eminence（according to Meyers and Mckeever classification,type Ⅰ 1 case,type Ⅱ 13 cases,type Ⅲ 3 cases） received the arthroscopic treatment.The surgical approach was both sides of the patellar ligament,the fracture reduction was performed under arthroscopy,and then the Kirschner wire was inserted from a point medial to the tibial tubercle to hold the intraarticular fracture fragments.The epidural tube was first penetrated through the Kirschner wire hole,and then the guiding tension suture（No.2 polyethylene line,diameter was 0.5-0.7 mm） was penetrated through the epidural tube to fix the bone block.Results Sixteen patients were followed up for 2 to 36 months,14 cases were healed in 12 weeks,other 2 cases in 18 weeks.14 cases（87.5%） recovered completely with a good joint stability and negative drawer test;other 2 cases gained a good functional recovery with a good joint stability but positive drawer test.Conclusion Arthroscopic surgery,with a small incision,simple operation,less postoperative injury,secure internal fixation,is an effective method for the ACL tibial avulsion fracture.The early functional exercise of knee joint should improve the recovery of knee.

关 键 词：关节镜 前交叉韧带 胫骨骨折 外科张力缝线 

分 类 号：R686.5[医药卫生—骨科学] R683.423[医药卫生—外科学]