关节镜下胫骨髁间隆突撕脱骨折的治疗  

A Study Of Arthroscopic Treatment for The Tibia Intercondylar Eminence Fracture

作　　者：张志成[1,2] 潘昭勋[2] 崔岩[2] 翟龙地[2] 陈修福 

机构地区：[1]潍坊医学院,山东潍坊261042 [2]解放军89医院,261042 [3]青岛市立医院,山东潍坊261042

出　　处：《健康必读（下）》2012年第1期1-1,6,共2页

摘　　要：目的：探讨关节镜下微创技术治疗胫骨髁间隆突撕脱骨折的几种手术方法，并观察其疗效。方法：2006年1月至2011年5月，对我科收治的胫骨髁间隆突撕脱骨折的患者，进行关节镜下微创治疗，共30例，其中男18例，女12例。新鲜损伤26例，陈旧损伤4例；伴内侧半月板前角一起撕裂者4例；伴半月板其它部位损伤6例。10例髁间隆突撕脱骨折，应用带线锚钉交叉缝合复位，骨皮质外打结固定。12例采用多骨道、交叉缝线／钢丝缝合复住、骨皮质外打结固定。8例采用空心拉力螺钉固定。术中同时处理半月板损伤。术后即可进行10°—90°范围内的伸屈练习以防粘连。其它同交叉韧带重建渐进式训练。结果：全部患者均得到随访，平均随访14．5（3—31）个月，术后三个月有六例屈曲受限，活动范围0°—90°，至术后6个月，屈曲度达110°-130°，其余患者均恢复正常膝关节活动范围。X光片示骨折骨性愈合，个别病例粉碎性小骨片翘起但对功能无影响。伴有半月板前撕裂一起缝合的患者，恢复良好，复查无半月板损伤的症状、体征。2例lachman试验轻度阳性。按lysholm功能评分术后6—8个月平均为91．6。结论：对于胫骨髁间隆突撕脱骨折患者进行关节镜下治疗，创伤小，固定牢固，功能效果良好。术中应根据撕脱骨块的大小，选择不同的固定方法及材料。对于连带半月板前角撕裂的病例，一同缝合固定，可避免半月板的切除。Objective ： To explore some techniques of reduction arid internal fixation for tibia iritercondylar eminence fractures under arthroscopy, and evaluate the efficaey of these surgery treatments. Methods： Between January 2006 and May 2011,30 patients （18 men and 12 women） with tibia intercondylar eminence fractures were treated with arthroscopie reduction and fixation using arthroscopie screw, nonabsorbable sutures / Steel wires and suture anchors, of which 2 cases were obsolete fractures and other 28 cases were fresh fractures. Besides,4 cases were associated with the anterior horm of meniscus injury,and 6 cases were with other parts of the meniscus injury. 12 patients with tibia intercondylar eminence fracture were treated with arthrnscopic reductiort and fixation using nonabsorbable sutures/stainless steel wire, 10 patients ueing suture anchors and 8 patients using arthroscopic screw. We also treated the meniscus injury during the surgery. After the surgery we give a exercise of 10°-90° ROM for each patient to prevent the joint adhesion. The uther function exercise for these patients was jast the same as the progressive training of the reconstruction of anterior cruciate ligament. Results：An the patients were followed up 14.5months（ range,3 - 31 months）. 6 patients had flexion restriction of the knee and the ROM was 0°-90°at 3 months,but the average flexional fuan tion of the knee improved to 110°--130°after 6 months. The other patients＇ s ROM of the knee turn into a normal range. The X -ray films showed good reduction of fracture and fracture healing in all of the patients except some individuals with comminuted fractures, who had some small bone chip tilter but did no adverse effects to the fuction of the knee. All the patients with meniscus sutured or repaired showed a good recovery and there were no symptoms and signs of meniscus injury after treatment. The results of Lachman test was weakly positive in 2 cases. The mean Lysholm score was 94.5（range,87--98） at fi -8 months after the

关 键 词：胫骨髁间隆突撕脱骨折 治疗 关节镜技术 手术方法 

分 类 号：R687.3[医药卫生—骨科学]