关节镜下钢丝三维缝合固定儿童胫骨髁间嵴撕脱骨折的疗效  

Arthroscopy-assisted 3-D saturation using steel wire for fixation of fracture with tibia intercondylar emi-nence in children

作　　者：郭永智[1] 姜鑫[1] 孙延山[1] 张益民[1] 

机构地区：[1]山东省潍坊市人民医院关节科,山东261041

出　　处：《中华小儿外科杂志》2012年第6期434-436,共3页Chinese Journal of Pediatric Surgery

摘　　要：目的探讨关节镜下改良钢丝缝合固定儿童胫骨髁问嵴撕脱骨折的疗效。方法2006-2010年在关节镜下用改良钢丝缝合固定18例胫骨止点撕脱骨块患儿，18例meyers mckeever分型Ⅲ型儿童前交叉韧带胫骨止点撕脱骨折患儿，在关节镜下复位，在胫骨结节旁，骨骺线上方用2．0mm克氏针向胫骨骨折面内、外缘中部各钻一骨道。用自制缝针从内向外穿过韧带骨块结合部前中1／3及中后1／3处各穿1根双股1号聚乙烯缝线，用钩针分别经过两骨道至ACI．缝线处，用钩针将ACL内、外两端缝线拖至胫骨结节处。再将其中一根缝线做牵引线，牵引双股0．6mm钢丝从胫骨结节处经由骨洞穿入、穿过ACL与骨块结合部、经由另一骨洞穿出至胫骨结节。将骨块复位，钢丝和缝线分别打结双重、三维固定骨块。术后无需外固定，可早期活动。结果所有患儿术后随访3-12个月（平均8个月）。患儿关节活动度皆正常，前抽屉试验、轴移试验、Lachman试验皆阴性，术后X线片示骨折复位良好，骨块无移位及翘起。术后8-10周骨折均愈合，Lysholm评分平均为98．3分。结论采用该方法镜下缝合固定儿童前交叉韧带胫骨止点撕脱骨折，手术简便，对骨骺无损伤，固定牢靠，患肢无需外固定，可以早期活动。Objective To investigate the efficacy of arthroscopy-assisted 3 D saturation using steel wire for fixation of fracture with tibia intercondylar eminence in children. Methods Between 2006 and 2010, 18 children associated with fracture combined with tibia intercondylar eminence, underwent surgery in our center. Under the assistance of arthroscopy, Kirschner wire was used to screw two tun- nels from inner and outer platform respectively. The sutures was lead to pass through the tunnels to ACL sutures using hook and fixed them in sites of ACL junction with bone and tibia tubercles respec- tively. External fixation was not need. Results The average follow-up time is 8 months （Ranging 3 to 12 months）. Range of motion in all patients was normal. Anterior drawer test, pivot shift and l.ach- man test indicate negative signs. X rays demonstrated a better fracture reduction. The healing time ranged from 8-10 weeks in post-surgery. Lysholm scoring for them was 98.3. Conclusions Arthrosco- py-assisted 3-D saturation using steel wire for fixation of fracture is easy to operate and cannot damage epiphysis. Meanwhile, it fixes well for the fracture and external fixation is not needed.

关 键 词：胫骨骨折 前交叉韧带 关节镜 

分 类 号：R726.8[医药卫生—儿科]