关节镜下带孔克氏针辅助缝线固定胫骨髁间嵴骨折的临床疗效  

Clinical effect of arthroscopic reduction and suture for tibial intercondylar eminence fractures by perforated Kirschner wire

作　　者：刘飞 侯华成 鞠黎 冒锋涌 唐凯 Liu Fei;Hou Huacheng;Ju Li;Mao Fengyong;Tang Kai(Department of Orthopedics,Children's Hospital of Nanjing Medical University,Nanjing 210008,China)

机构地区：[1]南京医科大学附属儿童医院骨科,南京210008

出　　处：《中华实用儿科临床杂志》2023年第9期693-697,共5页Chinese Journal of Applied Clinical Pediatrics

摘　　要：目的探讨关节镜下辅助复位,2.0 mm带孔克氏针建立骨隧道,不可吸收缝线"8"字缝合固定儿童胫骨髁间嵴骨折的临床疗效。方法回顾性分析2018年1月至2020年12月南京医科大学附属儿童医院收治的胫骨髁间嵴骨折患儿24例的临床资料。24例中,男14例,女10例;年龄6~15岁。患儿均采用关节镜下骨折复位,高强度不可吸收缝线前交叉韧带基底部"8"字缝合,经胫骨近端骨骺2.0 mm带孔克氏针钻孔建立骨隧道并过线,关节外打结固定骨折块,术后石膏固定4周,4周后拆除石膏主动功能锻炼。术后采用Lysholm评分和IKDC2000主观评分评估膝关节功能恢复情况,Lachman试验评估膝关节稳定性,术后3、6个月复查X线片评估骨折愈合情况,术后2年摄双膝X线片评估是否存在骨骺早闭情况。结果24例患儿均顺利完成手术,手术时间40~115 min[(63.1±20.2)min]。患儿均随访,随访时间24~36个月[(28.7±3.4)个月]。术后X线片解剖复位,未见骨折再移位、缝线断裂及感染等并发症,术后3个月均骨性愈合。末次随访时膝关节功能评分Lysholm评分(94.4±4.8)分;IKDC2000主观评分(93.8±5.6)分,2例患儿Lachman试验阳性,均未发现胫骨近端骨骺生长受抑制。结论采用关节镜辅助复位,2.0 mm带孔克氏针建立胫骨隧道,不可吸收缝线"8"字缝合治疗儿童胫骨髁间嵴骨折,具有关节内操作简单、手术创伤小等优点,是一种有效的手术方式。Objective To investigate the clinical effect of arthroscopic reduction of tibial intercondylar ridge fractures in children using a 2.0 mm perforated Kirschner wire to establish bone tunnels and the Krackow-"8"suture.Methods From January 2018 to December 2020,24 children(14 males and 10 females,aged 6-15 years)with tibial intercondylar ridge fractures admitted to Children′s Hospital of Nanjing Medical University were retrospectively recruited for analyses.All patients were treated with arthroscopic reduction,non-absorbable Krackow-"8"suture for the base of the anterior cruciate ligament,and establishment of bone tunnels by 2.0 mm perforated Kirschner wire from the proximal tibial epiphysis for inserting a suture to fix the fractures.The affected limb was immobilized with a cast for 4 weeks,followed by active exercises postoperatively.Knee function was assessed using the Lysholm score and IKDC 2000 subjective score.Knee stability was evaluated using the Lachman test.X-rays were taken at 3 and 6 months postoperatively to evaluate fracture healing.Growth retardation of epiphyseal plate at 2 years of follow-up was assessed by bilateral knee X-rays.Results All the 24 cases were successfully operated,with the operation time of(63.1±20.2)(40-115)min.All children were followed up for 24-36 months[(28.7±3.4)months].All children achieved an anatomical reduction of the fracture postoperatively.No complications like fracture displacement,suture rupture,or infection were reported.All fractures healed completely at 3 months postoperatively.At the last follow-up,the Lysholm score and IKDC 2000 subjective score were(94.4±4.8)points and(93.8±5.6)points,respectively.The positive Lachman test was detected in 2 patients.No inhibition of proximal tibial epiphyseal growth was observed.Conclusions Arthroscopic reduction with non-absorbable Krackow-"8"suture and establishment of bone tunnels using a 2.0 mm perforated Kirschner wire for the treatment of tibial intercondylar ridge fractures in children has the advantages of simple su

关 键 词：胫骨 骨折 内固定 关节镜 克氏针 

分 类 号：R726.8[医药卫生—儿科]