关节镜治疗儿童胫骨髁间棘撕脱骨折24例分析  

The arthroscopic treatment for children with tibial intercondylar eminence avulsion fractures：a report of 24 cases

作　　者：吴星火[1] 段德宇[1] 何宇[1] 方为志[1] 苏正兵[1] 孟春庆[1] 王洪[1] 杨述华[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院骨科,武汉431022

出　　处：《中华小儿外科杂志》2013年第6期434-437,共4页Chinese Journal of Pediatric Surgery

摘　　要：目的探讨经关节镜下骨折块复位，辅助PDS-1I丝线内固定治疗儿童胫骨髁间棘撕脱骨折的临床效果。方法选择我院自2009年1月至2010年12月间胫骨髁间棘撕脱骨折的患儿24例（男16例，女8例，年龄8～14岁），采用经关节镜下骨折块复位，以类似成人前交叉韧带重建方式，自胫骨结节内上方1cm（骨骺上方）以胫骨定位器定位，以直径1～1．2mm克氏针钻孔，然后以16号腰穿针导入2根不可吸收的PDS-11丝线将骨折块及前交叉韧带与胫骨止点进行交叉捆扎固定。术后定期进行随访，根据IKDC、Lyshohn膝关节功能评分进行功能恢复评估。结果本组24例患儿随访6～30个月，术后复查X线显示骨折复位满意，均实现骨性愈合。末次随访，患肢膝关节活动范围恢复满意，无关节僵硬、关节松弛、功能障碍等表现；无骨骺损伤并发症，随访期间未发现患儿出现发育畸形。Lysholm评分由术前（48．6±7．2）分提高到术后（94．5±4．1）分，IKIX22000主观膝关节评分由术前（53．5±4．8）分提高到术后（92．8±3．7）分，差异均有统计学意义（P〈0．001）。结论经关节镜下骨折块复位并采用PDS-1I丝线固定儿童髁问棘撕脱骨折，是一种较好的方法。Objective To explore minimally invasive treatment for tibial intercondylar eminence avulsion fractures under arthroscopy. Methods From Jan 2009 to Dec 2010, 24 patient with skeletal immaturity （16 boys and 8 girls, 8~14 years old） underwent the arthroscopic reduction and PDS-U suture fixation of the anterior cruciate ligament or the avulsion fracture. Having taken the advantage of ACL-aimer, the sutures were pulled out and tied outside the joint accurately. According to the stand- ard of International Knee Documentation Committee （IKDC）, the Lysholm knee scoring method was used to measure the knee function preoperatively and postoperatively. Results Twenty-four patients were followed up for 6 to 30 months. All patient gained normal range of motion, and the X ray exami- nation demonstrated bone union in all the cases. At the end of the follow-up, all the patients got im proved range of movement without complications such as joint stiffness, joint relaxation, epiphyseal injury or malformations dysfunction. The mean Lysholm knee scores were improved from 48. 6 ± 7. 2 preoperatively to 94. 5 ± 4. 1 at the end of the follow up period （P〈0. 001）and the mean IKDC subjec- tive evaluation scores were increased from 53.5 ± 4. 8 preoperatively to 92. 8 -± 3.7 at the end of the follow-up period （P〈0. 001）. Conclusions The arthroscopical operation with absorbable suture fixa- tion, which leads to less trauma, is a simple and effective alternative for patients with the avulsion fracture of tibial intercondylar eminence.

关 键 词：关节镜 骨折 胫骨 治疗结果 

分 类 号：R687.3[医药卫生—骨科学]