关节镜下骨隧道缝线固定与空心螺钉固定治疗胫骨髁间棘骨折的疗效对比  

Efficacy of arthroscopic fixation of tibial eminence fracture using trans-tibial suture tape cerclage vs.cannulated screw

作　　者：孔长旺 李姣[2] 郝东阳 李谓林 魏世隽[1] 兰生辉[1] 付强[1] 陈家 汤明 KONG Chang-wang;LI Jiao;HAO Dong-yang;LI Wei-lin;WEI Shi-jun;LAN Sheng-hui;FU Qiang;CHEN Jia;TANG Ming(Department of Orthopaedics, Wuhan General Hospital of PLA, Wuhan 430070, Chin)

机构地区：[1]中国人民解放军武汉总医院骨科运动医学中心,武汉430070 [2]湖北省中医院骨科,武汉430060 [3]空军汉口王家墩干休所卫生所,武汉430030 [4]湖北中医药大学,武汉430060

出　　处：《骨科》2018年第3期182-187,共6页ORTHOPAEDICS

基　　金：湖北省自然科学基金(ZRMS2017000091)

摘　　要：目的观察并比较关节镜下骨隧道缝线固定与空心螺钉固定治疗胫骨髁间棘骨折的临床疗效。方法对2009年1月至2013年11月期间中国人民解放军武汉总医院通过关节镜手术治疗胫骨髁间棘骨折并获得随访的62例病人的临床资料进行回顾性分析,根据手术固定方法不同分为骨隧道缝线固定组(28例)和螺钉固定组(34例)。比较两组的平均手术时间、膝关节屈伸活动度;采用Lysholm膝关节评分量表、2000国际膝关节评分委员会(International Knee Documentation Committee,IKDC)膝关节主观评价问卷对膝关节功能进行评价;采用轴移试验、Lachman试验评价膝关节稳定性;标准膝关节正侧位X线片评价骨折愈合情况。结果随访12~32个月,平均16.5个月,两组的平均手术时间相近,且术后病人均未出现膝关节屈伸活动受限。缝线固定组手术前后的Lysholm评分分别为(50.46±4.59)分、(92.25±2.82)分,2000 IKDC膝关节主观评分由术前的(49.29±8.49)分提高到术后的(90.86±3.38)分;螺钉固定组手术前后的Lysholm评分分别为(49.06±3.85)分、(91.76±7.34)分,2000 IKDC膝关节主观评分由术前的(47.00±8.31)分提高到术后的(90.29±2.78)分;术后评分均明显优于术前,差异均有统计学意义(t=-38.802,t=-21.730,t=-44.723,t=-28.102,P均<0.001),但两组组间比较,差异均无统计学意义(P均>0.05)。两组术后轴移试验结果均为阴性,Lachman试验结果差异无统计学意义(χ2=0.033,P=0.856)。病人末次随访时均达到骨性愈合,未发现骨赘形成及髁间窝撞击表现。结论关节镜下采用骨隧道缝线固定或空心螺钉固定治疗胫骨髁间棘骨折均可获得牢靠固定,临床疗效理想,骨隧道缝线固定法在处理粉碎骨折及合并半月板损伤的手术操作方面更具优势。Objective To compare the effectiveness of arthroscopic fixation of tibial eminence fractureusing trans-tibial suture tape cerclage vs. cannulated screw. Methods From January 2009 to December 2013,the clinic data of 62 cases of tibial eminence fractures treated in our hospital were analyzed retrospectively.They were divided into suture group（28 cases） and screw group（34 cases） according to the procedures offixation. Operating time, range of motion of the knee, knee joint Lysholm and 2000 IKDC scores were evaluatedfor subjective function. Knee stability was evaluated by pivot shift test and Lachman test. Bone healing wasevaluated with X-ray films. Results All the cases were followed up for 12-32 months（average 16.5 months）.No significant differences were found between the two groups in terms of average operating time. There was nolimited by flexion or extension. The Lysholm and 2000 IKDC scores before and after operation were 50.46±4.59,49.29±8.49, 92.25±2.82, 90.86±3.38 in suture group, and those were 49.06±3.85, 47.00±8.31, 91.76±7.34,90.29 ± 2.78 in screw group, respectively. There were significant differences in the scores before and afteroperation（t=-38.802, t=-21.730, t=-44.723, t=-28.102, P〈0.001 for all）. There was no significant differencebetween the two groups（P〈0.05 for all）. The results of pivot shift test in the two groups were negative, andLachman test results showed no significant difference. X-ray films ultimately demonstrated that fracture healingwas satisfactory. Conclusion The arthroscopic procedure of tibial eminence fracture whatever using trans-tibial suture tape cerclage or cannulated screw can also acquire reliable reduction and fixation, obtain the idealknee joint stability and clinical effect. The trans-tibial suture tape cerclage exerts the ability to treatcomminuted fractures of tibial eminence fracture and fracture complicated with the meniscus lesion.

关 键 词：胫骨髁间棘骨折 关节镜检查 骨折固定术 内 

分 类 号：R687[医药卫生—骨科学]