关节镜引导下植骨、缝线内固定治疗胫骨髁间嵴骨折不愈合  

Arthroscope-guided Bone Grafting and Suture Fixation for Nonunion of Tibia Intercondylar Eminence Fracture

作　　者：徐海涛[1] 朱威宏[2] 曹斌[1] 舒子震 

机构地区：[1]湖南省第二人民医院骨科,长沙410007 [2]中南大学湘雅二医院骨科,长沙410011

出　　处：《中国现代手术学杂志》2017年第6期445-448,共4页Chinese Journal of Modern Operative Surgery

摘　　要：目的探讨关节镜引导下植骨、缝线内固定治疗胫骨髁间嵴骨折不愈合的临床疗效和安全性。方法 2014年7月~2016年10月共收治胫骨髁间嵴骨折不愈合患者8例,其中Ⅱ型4例,Ⅲ型4例,均采用关节镜引导下植骨、缝线内固定治疗。评估患者术前、术后3月、6月、12月Lysholm膝关节功能评分、关节活动度,前抽屉试验、Lachman试验评估关节稳定性,摄X片观察有无关节游离体。结果本组6例合并半月板损伤,其中内侧半月板损伤2例,外侧半月板损伤1例,内外侧半月板均有损伤3例;4例合并关节软骨损伤;自体骨植骨6例,同种异体骨植骨2例。7例获得随访,平均14.6(12~20)个月,1例术后2月失访。所有患膝术后8周均可完全伸直,屈曲130°以上。术后3月随访6例骨折愈合,1例术后4月复诊愈合。术后6月、12月5例ADT(-),2例ADT(+)(关节较健侧稍松弛,但有明确止点);5例Lachman试验(-),2例(+),但患者均无关节不稳定感,不需手术治疗。7例随访12月未见关节游离体。Lysholm膝关节评分:术前平均(82.9±7.3)分,术后6月随访平均(91.4±7.1)分,较术前显著提高(t=8.042,P<0.05);术后12月随访平均(96.6±4.6)分,亦较术前显著提高(t=9.731,P<0.05)。结论关节镜引导下植骨、缝线内固定是治疗胫骨髁间嵴骨折不愈合安全、有效方法。Objective To explore the effect and safety of arthroscope-guided bone grafting and suture fixation for nonunion of tibia intercondylar eminence fractures. Methods From July 2014 to October 2016,a total of 8 cases with tibia intercondylar eminence fracture nonunion were treated by arthroscope-guided bone grafting and fixation with suture,including 4 of type Ⅱ and 4 of type Ⅲ. Lysholm knee score and Rang of motion of knee were assessed before,3-,6-and 12 months after the surgery. Anterior drawer test（ADT） and Lachman test were used to evaluate knee stability. Loose bodies were observed by X-image.Results All 8 cases accomplished the surgery successfully. Combined meniscus injury were found in 6 cases,including medial meniscus in 2,lateral meniscus in 1 and medial-lateral in 3; Combined articular cartilage lesion was found in 4 cases. During the surgery,autogenous bone grafting was performed in 6 cases and allogenetic bone grafting in 2 cases. Followed-up duration ranged from 12 to 20 months in 7 patients,but loss in 1 case2 months after the surgery. All knees achieved full extention and 130° in flexion at least. The fracture healing time was 3 months in 6 cases and 4 months in 1 case. There were negative outcomes in 5 cases and positive outcomes in 2 cases in both ADT and Lachman test 6-and 1 2 months after the surgery,but no patient felt instable. No loose body was observed 1 2 months after the operation. The average Lysholm knee score of 6-and 12 months after the surgery was 91. 4 ± 7. 1 and 96. 6 ± 4. 6 respectively,both were improved significantly than 82. 9 ± 7. 3 of pre-operation,and the differences were statistically（t = 8. 042,P 0. 05,and t = 9. 731,P 0. 05）. Conclusion The surgical intervention of arthroscope-guided bone grafting and suture fixation is safe and effective for fracture nonunion of tibia intercondylar eminence.

关 键 词：关节镜检查 胫骨髁间嵴骨折 骨折 不愈合 膝关节 

分 类 号：R687.3[医药卫生—骨科学]