关节镜下经髌内侧入路空心钉固定治疗前交叉韧带胫骨止点撕脱骨折的疗效  

Observation on the therapeutic effect of arthroscopic hollow screw fixation through medial patellar approach for anterior cruciate ligament tibial avulsion fracture

作　　者：代朋乙 黄昌林[2] DAI Peng-yi;HUANG Chang-lin(Knee Injury Department,Luoyang Orthopedic-Traumatological Hospital,Henan Orthopedic Hospital,Luoyang,Henan 471002,China;Department of Orthopedics,150 Hospital of PLA,Luoyang,Henan 471031,China)

机构地区：[1]河南省洛阳正骨医院(河南省骨科医院)膝部损伤科,河南洛阳471002 [2]解放军150医院骨科,河南洛阳471031

出　　处：《解放军医学杂志》2018年第12期1049-1053,共5页Medical Journal of Chinese People's Liberation Army

摘　　要：目的探讨关节镜下经髌内侧入路空心钉固定治疗前交叉韧带胫骨止点撕脱骨折的手术方法及效果。方法选择2014年7月-2017年12月行关节镜下经髌骨内侧入路空心钉固定技术治疗的前交叉韧带胫骨止点撕脱骨折患者26例,术前Meyers-McKeever-Zaricznyj分型Ⅱ型10例、Ⅲ型16例,均为新鲜骨折。26例中男18例,女8例,年龄19～50(26.3±3.3)岁。比较所有患者手术前后的前抽屉试验、Lachman试验、Lysholm膝关节功能评分及国际膝关节文献委员会(IKDC)评分。所有手术均由同一手术团队完成。结果术后随访6～14(11.2±1.5)个月,2例失访。术后3个月X线片示骨折均愈合,未发生螺钉松动、断裂及再骨折等。术后末次随访时,患膝主动活动度为伸0°,屈130°～150°(平均138°);前抽屉试验及Lachman试验均由术前的阳性转为阴性;Lysholm膝关节功能评分由术前的(46.50±3.31)分增加至末次随访时的(89.13±2.52)分,差异有统计学意义(t=50.13,P<0.01);IKDC评分入院时均为显著异常(D级),末次随访时正常(A级)22例(91.67%,22/24)、接近正常(B级)2例(8.33%,2/24)、异常(C级)0例。结论关节镜下经髌内侧入路空心钉固定治疗前交叉韧带胫骨止点撕脱骨折具有骨块固定牢固、利于骨折早期愈合、可早期功能锻炼及膝关节功能恢复良好等优点,适用于Meyers-McKeever-ZaricznyjⅡ型、Ⅲ型骨折。Objective To investigate the surgical method and clinical effect of arthroscopic fixation of tibial avulsion fracture of the anterior cruciate ligament(ACL)with hollow screw via medial patellar approach.Methods From July 2014 to December 2017,26 ACL patients,including 18 males and 8 females,with an average age of(26.3±3.3)years,ranging from 19 to 50 years,were treated by arthroscopic hollow screw fixation through medial patellar approach.According to Meyers-McKeeverZaricznyj before operation,there were 10 cases of typeⅡfracture and 16 cases of typeⅢ,all of which were fresh fractures.The preoperative and postoperative anterior drawer test,Lachman test,Lysholm knee function score and International Knee Documentation Committee(IKDC)score were compared.All the operations were performed by the same operation team.Results The follow-up period ranged from 6 to 14 months with an average of(11.2±1.5)months,and 2 patients were lost to follow-up.X-ray radiographs showed that all fractures healed 3 months after the surgery,and there was no case of screw loosening,fracture or re-fracture.At the last follow-up after surgery,the active range of the affected knee was extension 0°,flexion 130°-150°with an average of 138°.Both the anterior drawer test and Lachman test changed from positive to negative before surgery;Lysholm’s knee function score improved from(46.50±3.31)points before operation to(89.13±2.52)points at the last follow-up,the difference was statistically significant(t=50.13,P<0.01).IKDC scores were significantly abnormal(grade D)at admission,but at the last follow-up,22 patients achieved normal(grade A)(91.67%,22/24),2 were close to normal(grade B)(8.33%,2/24),there was no abnormal(grade C)cases.Conclusion Arthroscopic hollow screw fixation through medial patellar approach in treatment of ACL has the advantages of firm bone block fixation,early healing of fracture,early functional exercise and functional recovery of knee and so on,and the clinical effect is good,and the method is applicable to Meyers-Mc

关 键 词：关节镜 前交叉韧带 胫骨骨折 骨折固定术 内 

分 类 号：R683[医药卫生—骨科学]