前交叉韧带断裂合并胫骨平台骨折的镜下一期治疗  

One-stage arthroscopic operations for anterior cruciate ligament tears accompanied with tibial plateau fractures

作　　者：冯杨 刘宁[1] FENG Yang;LIU Ning(Department of Sports Injury and Arthroscopy,Zhengzhou Orthopedic Hospital,Zhengzhou 450052,China)

机构地区：[1]郑州市骨科医院运动创伤关节镜科,河南郑州450052

出　　处：《中国矫形外科杂志》2021年第18期1702-1705,共4页Orthopedic Journal of China

摘　　要：[目的]评价关节镜下一期手术治疗前交叉韧带(anterior cruciate ligament, ACL)损伤合并Schatzker Ⅲ型胫骨平台骨折的临床疗效。[方法] 2017年6月—2018年8月,本研究采用一期镜下重建术与复位内固定术治疗ACL损伤合并Schatzker Ⅲ型胫骨平台骨折26例患者。总结患者临床与影像资料。[结果] 26例均顺利手术,无血管、神经损伤等严重并发症。随访10~18个月。与术前相比,末次随访时Lachman试验、轴移试验和Lysholm评分均显著改善(P<0.05)。末次随访时,26例患者中,18例恢复至伤前运动水平,8例尚未恢复至伤前运动水平。影像方面,术后影像显示26例患者胫骨平台骨折复位,优16例,良9例,差1例。所有患者骨折均愈合,骨折愈合时间6~10周。至末次随访时,所有患者内植物无松动,骨隧道均无明显扩大,关节无明显退变。[结论]镜下一期单束解剖重建ACL和骨折复位内固定可避免分期手术,减少医源性损伤,疗效满意。[Objective] To evaluate the clinical efficacy of one-stage arthroscopic surgeries for anterior cruciate ligament(ACL) tears accompanied with Schatzker type Ⅲ tibial plateau fractures. [Methods] From June 2017 to August 2018, 26 patients underwent one-stage arthroscopic ACL reconstruction, as well as reduction and internal fixation of fractures for ACL tears accompanied with Schatzker type Ⅲ tibial plateau fractures. The clinical and imaging documents were summarized. [Results] All the 26 patients had operations performed smoothly without serious complications, such as vascular and nerve damage. The follow-up period lasted for 10 to 18 months. The Lachman test, pivot-shift test and Lysholm score significantly improved at the latest follow-up compared with those preoperatively(P<0.05). Of them, 18 patients had recovered to the pre-injury sports level, whereas other 8 patients remained under the pre-injury level at the latest follow-up. In terms of imaging evaluation, the quality of fracture reduction was marked as excellent in 16 cases, good in 9 cases, and poor in 1 case. All the patients got fractures healing in 6 to 10 weeks. By the time of the latest follow-up, no loosening of internal implant, no significant enlargement of bone tunnels, and no significant degeneration of the joints were found on radiographs in anyone of the 26 patients.[Conclusion] The one-stage anatomical ACL reconstruction combined with fracture reduction and internal fixation under the arthroscope do avoid staged surgeries, reduce iatrogenic injuries, and have satisfactory clinical outcomes.

关 键 词：膝关节 前交叉韧带断裂 胫骨平台骨折 关节镜术 一期手术 

分 类 号：R683.42[医药卫生—骨科学]