关节镜下可吸收钉内固定治疗儿童与青少年胫骨髁间棘骨折  

Arthroscopic fixation of anterior tibial spine fractures with bioabsorbable nails in skeletally immature patients

作　　者：冯超[1] 郭源[1] 田伟[1] 

机构地区：[1]北京大学第四临床医学院北京积水谭医院,100035

出　　处：《中华小儿外科杂志》2015年第5期339-342,共4页Chinese Journal of Pediatric Surgery

摘　　要：目的探讨关节镜下复位可吸收软骨钉固定治疗Ⅲ型儿童胫骨髁间棘骨折的疗效。方法2012年，治疗手法复位失败的Ⅲ型新鲜胫骨髁间棘撕脱性骨折患儿11例，其中男4例，女7例；平均年龄10岁。首先关节镜下探查是否有合并伤并予以处理，确定骨折块及交叉韧带损伤情况，之后行关节镜下复位内固定治疗。术后支具制动，早期功能锻炼。平均随访时间12个月（10～18个月），Lachnmn试验、轴移试验评价膝关节稳定性，Lysholm评分评价膝关节功能，术后X线片评价骨折愈合情况及是否存在骨骺早闭。结果11例骨折均获得并维持满意的复位，无内固定断裂、骨块松动，感染等严重并发症发生，无关节活动受限，末次随访时Lachnmn试验、轴移试验均阴性，Ly—sholm膝关节功能评分（97．3±1．8）分，术后3个月内X线片显示骨性愈合，末次随访时X线片检查未见骺板早闭现象。结论关节镜下复位可吸收软骨钉固定治疗Ⅲ型儿童胫骨髁间棘骨折，可有效重建膝关节的稳定，改善膝关节功能，创伤小，避免二次手术。Objective To evaluate an arthroscopic technique using bioabsorbable nails in displaced anterior tibial spine fractures. Methods A total of 11consecutive patients aged 7 to 14 years with anterior tibial spine fractures type Ⅲ according to the criteria of Meyers and McKeever were selected to undergo arthroscopic fragment fixation using bioabsorbable nails. After 10-18 months, they were evaluated with regard to anterior knee laxity, range of motion and Lysholm knee scoring scale. Results None of them had increased anterior knee laxity. The range of motion of all knee joints was normal. All reductions were excellent according to the Lysholm knee scoring scale. There was no inflammatory reaction and all fractures healed without complications. Conclusions For avulsed fracture of tibial intercondylar eminence in chkldren, arthroscopic treatment offers multiple advantages of minimal trauma, simple handling and stable fixation. And the outcome is comparable with other procedures. A second operation for removal of metallic implant is thus avoided.

关 键 词：关节镜检查 儿童 骨折固定术 内 胫骨 

分 类 号：R726.8[医药卫生—儿科]