关节镜下空心钉固定和高强度缝线固定治疗胫骨髁间棘骨折的疗效比较  

Cannulated screw fixation versus high-strength suture fixation in arthroscopy of tibial intercondylar fracture

作　　者：于志毅[1] Yu Zhiyi(Department of Orthopaedics,Beijing Renhe Hospital,Beijing 102600,China)

机构地区：[1]北京市仁和医院骨科,102600

出　　处：《中华创伤骨科杂志》2020年第2期166-169,共4页Chinese Journal of Orthopaedic Trauma

摘　　要：目的比较关节镜下空心钉固定和高强度缝线固定治疗胫骨髁间棘骨折的疗效。方法回顾性分析北京仁和医院2015年2月至2018年2月期间收治的31例胫骨髁间棘骨折患者资料,男18例,女13例;年龄21~51岁,平均34.3岁。根据固定方式不同将31例患者分为2组:13例患者采用关节镜下空心钉固定治疗(空心钉组),骨折根据McKeever分型:Ⅱ型5例、Ⅲ型8例。18例患者采用关节镜下高强度缝线固定治疗(高强度缝线组),骨折根据McKeever分型:Ⅱ型6例,Ⅲ型12例。术后比较两组患者手术时间、住院时间、骨折愈合时间、膝关节Lysholm评分、二次手术率等评定各自的临床效果。结果空心钉组和高强度缝线组胫骨髁间嵴骨折患者术前一般资料比较差异均无统计学意义(P>0.05),具有可比性。所有患者术后获12~44个月(平均24.8个月)随访。空心钉组和高强度缝线组患者手术时间分别为(91.6±7.6)、(91.9±7.4)min,住院时间分别为(11.5±2.9)、(11.4±2.3)d,骨折愈合时间分别为(3.3±0.5)、(3.3±0.6)个月,以上项目两组间比较差异均无统计学意义(P>0.05)。术后12个月采用Lysholm评分评定疗效:空心钉组为65~100分,优良率为92.3%(12/13);高强度缝线组为60~100分,优良率为94.4%(17/18),两组比较差异无统计学意义(P>0.05)。空心钉固定组中10例患者(76.9%)行二次关节镜手术取出内固定物,高强度缝线组无患者行二次关节镜手术。结论空心钉固定或高强度缝线固定治疗胫骨髁间棘骨折均可以达到满意的临床效果,高强度缝线固定在二次手术率方面低于空心钉固定。Objective To compare the cannulated screw fixation versus high-strength suture fixation in arthroscopy of tibial intercondylar fracture.Methods A retrospective analysis was performed of the 31 patients with tibial intercondylar fracture who had been treated from February 2015 to February 2018 at Department of Orthopaedics,Beijing Renhe Hospital.They were 18 males and 13 females with an average age of 34.3 years(range,from 21 to 51 years).Arthroscopic cannulated screw fixation was conducted in 13 patients(screwing group),5 of whom were McKeever typeⅡand 8 of whom McKeever typeⅢ.Arthroscopic high-intensity suture fixation was used in 18 patients(suture group),6 of whom were McKeever typeⅡand 12 of whom McKeever typeⅢ.The 2 groups were compared postoperatively in terms of operation time,hospitalization time,fracture healing time,Lysholm knee scores and rate of secondary operation.Results The 2 groups were comparable because there were no significant differences in preoperative general data between them(P>0.05).All the patients were followed up for 12 to 44 months(mean,24.8 months).For the screwing and suture groups,respectively,operation time was 91.6 min±7.6 min and 91.9 min±7.4 min,hospitalization time 11.5 d±2.9 d and 11.4 d±2.3 d and fracture healing time 3.3 mon±0.5 mon and 3.3 mon±0.6 mon,showing no significant differences between the 2 groups(P>0.05).By the Lysholm scores at 12 months after operation,the screwing group scored from 65 to100 points with an excellent and good rate of 92.3%(12/13),and the suture group from 60 to 100 points with an excellent and good rate of 94.4%(17/18),showing no significant difference between the 2 groups(P>0.05).Ten patients(76.9%)in the screwing group had secondary arthroscopy to remove the implants but none in the suture group did.Conclusions Both cannulated screw fixation and high-strength suture fixation can achieve satisfactory clinical results in the arthroscopy of tibial intercondylar fractures,but the latter may lead to a lower rate of secondary operation

关 键 词：关节镜 骨折固定术 内 骨钉 高强度缝线 胫骨髁间棘骨折 

分 类 号：R687[医药卫生—骨科学]