关节镜下胫骨隧道法与骺板规避法缝线固定治疗儿童前交叉韧带胫骨止点撕脱骨折的比较研究  

A comparative study of tibial tunneling method versus epiphyseal plate evading method in arthroscopic fixation with suture for treatment of anterior cruciate ligament tibial insertion avulsion fractures in children

作　　者：刘玉强[1] 郭旗[1] 梁振雷[1] 王续鹏[1] 胡滨[1] 刘宁[1] 

机构地区：[1]河南省郑州市骨科医院,河南郑州450052

出　　处：《中医正骨》2017年第6期12-15,24,共5页The Journal of Traditional Chinese Orthopedics and Traumatology

摘　　要：目的:比较关节镜下胫骨隧道法与骺板规避法缝线固定治疗儿童前交叉韧带胫骨止点撕脱骨折的临床疗效和安全性。方法:回顾性分析27例儿童前交叉韧带胫骨止点撕脱骨折患者的病例资料,其中采用关节镜下胫骨隧道法缝线固定15例,采用关节镜下骺板规避法缝线固定12例。男20例,女7例;年龄5~14岁,中位数10岁;按Meyers-Mckeever胫骨止点撕脱骨折分型,Ⅱ型17例、Ⅲ型10例;受伤至手术时间5~34 d,中位数14 d。分别比较术前和末次随访时2组患者的膝关节活动度、Lysholm膝关节评分和国际膝关节文献委员会(the international knee documentation committee,IKDC)膝关节评分,并比较2组患者胫骨骺板损伤发生情况。结果:术前2组患者膝关节活动度、Lysholm膝关节评分、IKDC膝关节评分比较,组间差异均无统计学意义[38.67°±6.20°,39.92°±7.42°,t=0.480,P=0.640;(40.87±6.32)分,(41.75±6.25)分,t=0.360,P=0.720;(50.01±5.71)分,(47.42±4.91)分,t=1.240,P=0.230]。末次随访时,2组患者膝关节活动度、Lysholm膝关节评分、IKDC膝关节评分比较,组间差异均无统计学意义[131.07°±8.60°,131.33°±9.21°,t=0.080,P=0.940;(92.73±4.43)分,(92.81±4.01)分,t=0.110,P=0.910;(93.27±3.92)分,(93.92±3.18)分,t=0.470,P=0.650];2组患者膝关节活动度、Lysholm膝关节评分、IKDC膝关节评分均高于术前(t=31.250,P=0.000,t=31.070,P=0.000;t=25.720,P=0.000,t=25.740,P=0.000;t=22.940,P=0.000,t=22.890,P=0.000)。胫骨隧道法固定组4例术后出现胫骨近端持续轻度疼痛,1例术后13个月在骺板内有骨桥形成;骺板规避法固定组无胫骨骺板损伤表现;骺板规避法固定组胫骨骺板损伤发生率低于胫骨隧道法固定组(P=0.047)。结论:对于儿童前交叉韧带胫骨止点撕脱骨折患者而言,关节镜下胫骨隧道法与骺板规避法缝线固定在改善膝关节活动度、恢复膝关节功能方面无明显差异,但骺板规避法固定较胫骨隧道法固定能更好地Objective： To compare the clinical curative effect and safety of tibial tunneling method versus epiphyseal plate evading method in arthroscopic fixation with suture for treatment of anterior cruciate ligament（ ACL） tibial insertion avulsion fractures in children.Methods： The medical records of 27 children with ACL tibial insertion avulsion fractures were analyzed retrospectively. Fifteen children were treated with arthroscopic fixation with suture by using tibial tunneling method（ group A）,while the others were treated with arthroscopic fixation with suture by using epiphyseal plate evading method（ group B）. The children consisted of 20 boys and 7 girls,aged 5-14 years（ Median = 10 yrs） and ranged in disease course from 5 to 34 days（ Median = 14 days）. The fractures belonged to Meyers-Mckeever typesⅡ（ 17） andⅢ（ 10）. The range of motion（ ROM） of knee,Lysholm knee scores and the international knee documentation committee（ IKDC）scores were recorded and compared between the 2 groups before treatment and at the last follow-up respectively. The incidence rate of tibial epiphyseal plate injuries were also compared between the 2 groups. Results： There was no statistical difference in knee ROM,Lysholm knee scores and IKDC knee scores between the 2 groups before the surgery and at the last follow-up（ 38. 67 ＋/-6. 20 vs 39. 92 ＋/-7. 42 degrees,t = 0. 480,P = 0. 640; 40. 87 ＋/-6. 32 vs 41. 75 ＋/-6. 25 points,t = 0. 360,P = 0. 720; 50. 01 ＋/-5. 71 vs 47. 42 ＋/-4. 91 points,t = 1. 240,P = 0. 230; 131. 07 ＋/-8. 60 vs 131. 33 ＋/-9. 21 degrees,t = 0. 080,P = 0. 940; 92. 73 ＋/-4. 43 vs 92. 81 ＋/-4. 01 points,t = 0. 110,P = 0. 910; 93. 27 ＋/-3. 92 vs 93. 92 ＋/-3. 18 points,t = 0. 470,P = 0. 650）. Knee ROM,Lysholm knee scores and IKDC knee scores were higher at the last follow-up compared to pre-surgery in the 2 groups（ t = 31. 250,P = 0. 000,t = 31. 070,P =0. 000; t = 25. 720,P = 0. 000,t = 25. 740,P = 0. 000; t = 22. 940,P = 0. 000,t = 22. 890,P = 0. 000�

关 键 词：前交叉韧带 胫骨 撕脱骨折 骨骺 关节镜检查 缝线 儿童 

分 类 号：R726.8[医药卫生—儿科]