关节镜下双头空心加压螺钉固定治疗前交叉韧带胫骨止点撕脱骨折的疗效  

Effect of arthroscopic treatment with double head compressive cannulated screw fixation on tibial eminence avulsion fracture of anterior cruciate ligament

作　　者：倪建龙[1] 时志斌[1] 樊立宏[1] 王昊宇 李涤尘[1] 党晓谦[1] 王坤正[1] NI Jianlong;SHI Zhibin;FAN Lihong;WANG Haoyu;LI Dichen;DANG Xiaoqian;WANG Kunzheng(First Department of Orthopedics,The Second Affiliated Hospital of Xi'an Jiao Tong University,Xi'an 710004,Shaanxi,China)

机构地区：[1]西安交通大学第二附属医院骨一科

出　　处：《中华骨与关节外科杂志》2019年第11期877-881,共5页Chinese Journal of Bone and Joint Surgery

摘　　要：背景:前交叉韧带(ACL)胫骨止点撕脱骨折临床较常见,保守治疗效果不佳,关节镜下复位固定是目前主要的治疗方法。目的:评价关节镜下双头空心加压螺钉固定治疗ACL胫骨止点撕脱骨折的临床疗效。方法:回顾性分析2015年3月至2017年6月收治的38例ACL胫骨止点撕脱骨折患者的临床资料。术后复查膝关节正侧位X线检查评估患者骨折复位及愈合情况,每次随访时均评估膝关节活动度并行Lachman试验及轴移试验,同时应用Lysholm及IKDC评分评估膝关节功能。比较患者末次随访时与术前Lysholm、国际膝关节文献委员会(IKDC)评分。结果:38例患者均获得随访,随访时间10~30个月,平均(15.3±3.4)个月。术后复查膝关节正侧位X线检查显示骨折均复位良好。随访中所有患者骨折均顺利愈合,愈合时间为2~4个月,平均(2.8±0.5)个月。术后有2例患者因功能锻炼不及时,末次随访时最大屈膝角度未达120°,但不影响日常生活,余患者末次随访时无屈伸活动受限,平均屈膝活动度为(130.2±4.3)°。患者末次随访时Lysholm、IKDC评分均高于术前,且差异均有统计学意义[(92.8±4.2)分vs(48.5±3.1)分,(93.3±4.5)分vs(50.2±2.8)分,t=22.652、21.375,P均<0.001]。所有患者末次随访时轴移试验均为阴性,12例患者Lachman试验Ⅰ度阳性,无Ⅱ度及以上阳性结果。结论:关节镜下双头空心加压螺钉固定治疗ACL胫骨止点撕脱骨折具有创伤小,固定可靠,恢复快的优点,值得临床推广。Background: Tibial eminence avulsion fracture of anterior cruciate ligament(ACL) is common clinically, and conservative treatment is not very effective. Arthroscopic reduction and fixation is the main treatment method at present. Objective: To evaluate the clinical efficacy of arthroscopic treatment of ACL tibial eminence avulsion fracture with double-head compressive cannulated screw fixation. Methods: Clinical data of 38 patients with ACL tibial eminence avulsion fracture treated from March 2015 to June 2017 were analyzed retrospectively. The postoperative anteroposterior and lateral X-ray of the knee was conducted to evaluate the reduction and healing of the fracture. During follow-up, the range of motion was detected, Lachman test and axial shift test of knee were performed, and Lysholm and IKDC scores were used to evaluate the function of knee.Results: The mean duration of follow-up was(15.3±3.4) months(range, 10-30 months) in all the 38 patients. Postoperative Xray showed good reduction of all the fractures, and the fractures were healed in(2.8±0.5) months on average(2-4 months). Two patients did not do functional exercise in time postoperatively, and the maximum angle of knee flexion was not up to 120°, but it did not affect daily life. The remaining patients had no limitation of flexion and extension at the last follow-up, and the mean range of knee flexion was 130.2°±4.3°. The Lysholm score and IKDC score at the last follow-up were significantly higher than preoperative ones(92.8±4.2 vs 48.5±3.1, 93.3±4.5 vs 50.2±2.8, t=22.652, t=21.375, P<0.001). The results of pivot shift test were all negative. The Lachman test of 12 patients was degree Ⅰ positive, and no degree Ⅱ or more positive results were found. Conclusions: The arthroscopic treatment of ACL tibial eminence avulsion fracture with double-head compressive cannulated screw fixation has the advantages of small trauma, reliable fixation and quick recovery. It is worthy of clinical application.

关 键 词：关节镜 双头空心加压螺钉 前交叉韧带 胫骨 撕脱骨折 治疗结果 

分 类 号：R687.4[医药卫生—骨科学]