关节镜下钢丝固定与空心螺钉固定治疗胫骨髁间嵴骨折的疗效比较  

Comparison between Arthroscopic Wire Fixation and Cannulated Screw Fixation for Fracture of Intercondylar Eminence of Tibia

作　　者：刘亚云[1] 余智锋 

机构地区：[1]江西省人民医院骨科,南昌330006 [2]修水县人民医院骨科,江西修水332405

出　　处：《实用临床医学（江西）》2013年第10期50-52,60,共4页Practical Clinical Medicine

摘　　要：目的比较关节镜下钢丝固定与空心螺钉固定治疗胫骨髁间嵴骨折的临床及功能效果。方法将25例胫骨髁间嵴骨折患者根据手术固定方法的不同分为A组(13例)和B组(12例)。A组采用关节镜下钢丝固定;B组采用关节镜下空心螺钉固定。分别于术后6周,3、6、12、18及24个月对患者临床及影像学进行随访,观察患者骨折复位及愈合情况。在末次随访时,采用前抽屉试验、Lachman试验及Lysholm评分对患者膝关节功能进行评估。结果 2组患者均手术顺利,A组和B组的手术时间分别为(180.2±12.4)min和(170.3±11.7)min,2组比较差异无统计学意义(P>0.05)。2组患者获得最终24个月的临床及影像学随访,随访中复查患者膝关节正、侧位X线片,均未出现骨折移位,所有病例均获骨性愈合。末次随访时,2组患者患侧膝关节前抽屉试验、Lachman试验均为阴性。A组Lysholm评分及膝关节屈伸活动度分别为(95.2±1.9)分及(142.1±9.0)°;B组Lysholm评分及膝关节屈伸活动度分别为(94.8±1.6)分及(138.6±12.1)°,2组比较差异均无统计学意义(均P>0.05)。结论关节镜下钢丝固定与空心螺钉固定治疗胫骨髁间嵴骨折均有良好的疗效,但关节镜下应用钢丝固定移位的胫骨髁间嵴撕脱性骨折适用范围广,操作简单,具有创伤小、固定可靠、关节功能恢复快及内固定物关节外取出方便的优点,是胫骨髁间嵴骨折治疗的理想方法。Objective To compare the clinical effects of arthroscopic wire fixation and cannulated screw fixation on the fracture of intercondylar eminence of the tibia. Methods Twenty-five patients with fracture of intercondylar eminence of the tibia were assigned to receive either arthroscopic wire fixation （group A, n= 13 ） or cannulated screw fixation （group B, n= 12）. Clinical and radiologic follow-up was performed to observe the reduction and healing of fractures 6 weeks and 3,6,12,18 and 24 months after operation. At the last follow-up, knee joint function was assessed by anterior drawer test, Lachman test and Lysholm score. Results All patients underwent operation successfully. The operation time was （180.2~12.4） minutes and （170.3＋11.7） minutes in group A and group B, respectively. The difference in operation time was not significant between the two groups （P〉0.05）. After 24 months of clinical and radiologic follow-up, anteroposterior and lateral x-ray films showed that no fractures were displaced and bony union was achieved in all patients. At the last follow-up, both anterior drawer test and Lachman test showed negative results.Lysholm score was（95.2~l.9） and（94.8~l.6） in group A and group B,respectively.The activity of knee flexion and extension was （142.1-＋9.0） ~and（ 138.6_＋12.1 ）~in group A and group B, respectively. Differences between the two groups were not statistically significant （P〉O.05 ）. Conclusion Both arthroscopic wire fixation and cannulated screw fixation are effective for the fracture of intereond- ylar eminence of the tibia. However,arthroscopic wire fixation has the advantages with wide applicat- ion, simple operation, small trauma,reliable fixation, few complications, quick recovery, and convenient removal of internal fixator. Therefore, arthroscopic wire fixation is an ideal method for the treatment of the fracture of intercondylar eminence of the tibia.

关 键 词：胫骨髁间棘骨折 关节镜 钢丝内固定 空心螺钉 

分 类 号：R683.42[医药卫生—骨科学]