关节镜下两种内固定方式治疗胫骨髁间棘骨折的疗效比较  

Comparison effects of two internal fixation methods for treatment of tibial intercondylar spine fractures under arthroscopy

作　　者：李晓[1] 杨克勤[1] 韦平欧[1] 秦豪[1] 梁俊杰 LI Xiao;YANG Ke-qin;WEI Ping-ou;QIN Hao;LIANG Jun-jie(Dept of Trauma and Sports Orthopaedics,Guigang City People′s Hospital,Guigang,Guangxi 537100,China)

机构地区：[1]贵港市人民医院创伤运动骨科,广西贵港537100

出　　处：《临床骨科杂志》2024年第6期880-884,共5页Journal of Clinical Orthopaedics

基　　金：广西壮族自治区贵港市科学技术局科研计划项目(贵科攻2021004号)。

摘　　要：目的比较关节镜下非吸收性缝线捆扎和经髌上入路空心埋头螺钉内固定治疗胫骨髁间棘骨折的疗效。方法将34例胫骨髁间棘骨折患者按照随机数字表法分为缝线组(采用关节镜下非吸收性缝线捆扎内固定治疗,17例)和螺钉组(采用关节镜下经髌上入路空心埋头螺钉内固定治疗,17例)。比较两组围手术期指标、骨折未愈合面积率、膝关节活动度、膝关节稳定度、Lysholm评分和IKDC评分。结果缝线组1例失访、螺钉组1例同侧股骨髁间骨折行手术治疗,故除围手术期指标外,其他指标均不予考察;32例获得随访,时间6~12个月。(1)手术时间螺钉组短于缝线组(P<0.01);切口长度、住院时间两组比较差异均无统计学意义(P>0.05)。(2)术后1、2、3个月骨折未愈合面积率缝线组均高于螺钉组(P<0.01)。(3)术后2、3、6个月膝关节伸直活动度螺钉组均优于缝线组(P<0.01);术后1、2、3个月膝关节屈曲活动度螺钉组均大于缝线组(P<0.05)。(4)手术当天及术后1、2、3、6个月膝关节稳定度螺钉组均优于缝线组(P<0.01)。(5)术后1、2、3个月Lysholm评分螺钉组均高于缝线组(P<0.01);术后1、2个月IKDC评分螺钉组均高于缝线组(P<0.01)。结论与非吸收性缝线捆扎内固定治疗相比,关节镜下经髌上入路空心埋头螺钉内固定治疗胫骨髁间棘骨折具有手术时间短、更利于骨折愈合、早中期膝关节功能恢复佳的优势。Objective To compare the effects of arthroscopy non absorbable suture binding and cannulated countersunk screw internal fixation with suprapatellar approach for treatment of tibial intercondylar spine fractures.Methods The 34 patients with tibial intercondylar spine fractures were randomly divided into the suture group(non absorbable suture binding and internal fixation under arthroscopy,17 cases)and the screw group(cannulated countersunk screw via the suprapatellar approach under arthroscopy,17 cases)accroding to random number table method.The perioperative indicators,fracture unhealed area rate,knee joint range of motion,knee joint stability,Lysholm score,and IKDC score were compared between the two groups.Results One case of the suture group was lost to follow-up,and 1 case of the screw group with ipsilateral femoral intercondylar fracture underwent surgical treatment.Therefore,except for perioperative indicators,all other indicators were not examined;32 cases were followed up for 6~12 months.①The surgical time in the screw group was shorter than that in the suture group(P<0.01);there were no statistical differences in incision length and hospital stay between the two groups(P>0.05).②At 1,2 and 3 months after surgery,the rate of unhealed fracture area in the suture group was all higher than that in the screw group(P<0.01).③At 2,3 and 6 months after surgery,the knee joint extension range of motion in the screw group was all better than that in the suture group(P<0.01);at 1,2 and 3 months after surgery,the knee flexion activity of the screw group was all greater than that of the suture group(P<0.05).④At 1 d,1,2,3 and 6 months after surgery,the stability of the knee joint in the screw group was all better than that in the suture group(P<0.01).⑤The Lysholm score of the screw group was higher than that of the suture group at 1,2 and 3 months after surgery(P<0.01);the IKDC score of the screw group was higher than that of the suture group at 1 and 2 months after surgery(P<0.01).Conclusions Compared with non

关 键 词：关节镜检查 髌上入路 非吸收性缝线固定 螺钉固定 胫骨髁间棘骨折 

分 类 号：R683.42[医药卫生—骨科学] R687.32[医药卫生—外科学]