关节镜下空心螺钉和钢丝治疗前交叉韧带胫骨止点撕脱骨折对比疗效分析  

Effect of Arthroscopic Treatment of Tibial Avulsion Fracture of Anterior Cruciate Ligament with Hollow Screws and Steel Wire

作　　者：牛金龙[1] 黄远章 王晋豫[1] 王勇卓 谭亚运[1] 马技[1] 张民[1] 

机构地区：[1]山西医科大学第二医院骨科,骨与软组织损伤修复山西省重点实验室,山西太原030001

出　　处：《实用骨科杂志》2016年第7期598-602,共5页Journal of Practical Orthopaedics

摘　　要：目的空心螺钉和钢丝是治疗前交叉韧带胫骨止点撕脱骨折常用的固定方法。即使一些生物力学研究比较了两者固定技术的稳定性,但是临床对照研究相对较少。本研究的目的是比较关节镜下空心螺钉和钢丝固定在前交叉韧带胫骨止点撕脱骨折的手术疗效。方法对我院2010年10月至2015年4月关节镜下治疗前交叉韧带胫骨止点撕脱骨折患者进行回顾性分析,根据内植物不同,分为空心螺钉组（11例）和钢丝组（21例）。随访内容包括膝关节功能及韧带的稳定性评价。采用Lysholm、IKDC及Tegner评分系统评价膝关节功能,通过Lachman试验及Pivotshift试验评价膝关节稳定性。结果本组32例患者均获随访,随访时间6~12个月,未发生切口及关节内感染等并发症。本研究中交通伤占75%,平均手术时间螺钉组为57 min、钢丝组为67 min（P〈0.05）。术后6个月时,Lysholm、IKDC、Tegner评分：螺钉组分别为（94.59±1.28）分、（93.95±1.50）分、（8.2±0.39）分;钢丝组分别为（93.98±1.16）分、（93.27±1.38）分、（8.2±0.33）分,（P值分别为0.182、0.203、0.878）。Lachman试验：螺钉组1例阳性,10例阴性,阳性率为9.1%;钢丝组1例阳性,20例阴性,阳性率为4.8%（P=1.000）,Pivot-shift试验：螺钉组1例阳性,10例阴性,阳性率为9.1%;钢丝组1例阳性,20例阴性,阳性率为5.3%（P=1.000）。结论关节镜下空心螺钉和钢丝治疗前交叉韧带胫骨止点撕脱骨折疗效满意,钢丝固定手术时间较长,但在膝关节功能和稳定性方面,两者并没有显著性差异。Objective The screw and steel wire is a common fixation method for the treatment of avulsion fracture of the tibial eminence. Even though some biomechanical studies have compared the stability of the two,the clinical reports are less.The aim of this study was to compare the efficacy of arthroscopic treatment of screw and wire fixation in tibial eminence avulsion fracture. Methods A retrospective analysis was made on the treatment of avulsion fracture of the tibial eminence between April 2015 and October 2010. The patients were divided intothe screw group（ 11 cases） and the steel wire group（ 21 cases）.All patients were followed up 6 ~ 12 months,including the knee joint function and the stability of the ligament. The knee joint function was evaluated by Lysholm,IKDC and Tegner scoring system. The stability of the knee joint was evaluated by Lachman test and Pivot-shift test. Results All the 32 cases were followed up,no complications such as incision and joint infection occurred. In this study,traffic injury was 75%,Median operatingtime was 57 minutes in screw fixation group and 67 minutes in steel wire group（P〈0. 05）. At the last follow-up,IKDC,Tegner and Lysholm score were（ 94. 59 ± 1. 28） 、（ 93. 95 ± 1. 50） 、（ 8. 2 ± 0. 39）,and the steel wire were（ 93. 98 ± 1. 16） 、（ 93. 27 ± 1. 38） 、（ 8. 2 ± 0. 33）. Lachman testwas negative in 10 patients,positive in 1 patients and negative in 20 patients,positive in 1 patients in group screw andsteel wire,respectively. Pivotshift testwas negative in 10 patients,positive in 1 patients and negative in 20 patients,positive in 1 patients in group screw and steel wire,respectively. Conclusion For the arthroscopic fixation of tibial avulsion fractures of the anterior cruciate ligament with screws and steel wire. Althoughthe latter has longer operation time,there is no significant difference in the function and stability of the knee joint.

关 键 词：前交叉韧带 胫骨髁间嵴 关节镜 撕脱骨折 

分 类 号：R683.42[医药卫生—骨科学]