关节镜下高强度缝线固定治疗儿童胫骨髁间嵴骨折疗效  

Arthroscopy high-strength suture fixation in the treatment of tibial spine avulsion fractures in children and adolescents

作　　者：张浩凯 朱丹江[1] 王强[1] 宋宝健[1] 冯伟[1] 文玉伟 ZHANG Hao-kai;ZHU Dan-jiang;WANG Qiang;SONG Bao-jian;FENG Wei;WEN Yu-wei(Department of Orthopedics,Beijing Children's Hospital,Capital Medical University,National Center for Children's Health,Beijing,100045,China)

机构地区：[1]国家儿童医学中心,首都医科大学附属北京儿童医院骨科,北京100045

出　　处：《中国骨与关节杂志》2025年第1期53-59,共7页Chinese Journal of Bone and Joint

基　　金：宋基会[法字(2022)175号]。

摘　　要：目的探讨关节镜下高强度缝线治疗儿童胫骨髁间嵴骨折(tibial spine avulsion fracture,TSAF)的临床疗效。方法回顾分析2020年1月至2022年12月我院收治的11例胫骨髁间嵴骨折患儿,其中男6例,女5例;年龄8~14岁,平均9岁;左侧5例,右侧6例;按Meyers-Mckeever分型,Ⅱ型5例,Ⅲ型4例,Ⅳ型2例。定期复查随访观察患儿骨折愈合情况、膝关节活动情况及并发症情况,采用Lysholm膝关节评分和国际膝关节文献委员会(International Knee Documentation Committee,IKDC)评分评价患肢膝关节功能。结果本组随访时间5~28个月,平均(17.7±8.8)个月,所有伤口均一期愈合,无伤口感染并发症。所有患者X线检查均显示骨折愈合,愈合时间9~14周,平均12.1周。无再移位、畸形愈合、不愈合。末次随访时膝关节屈曲活动受限2例(屈曲约0°~110°)。所有患儿前抽屉试验、Lachman试验阴性,X线未见骨骺损伤,无疼痛及僵硬等并发症,能完成日常生活自理及体育活动。Lysholm膝关节评分从术前32(25,37)分提高到100(98,100)分(Z=2.937,P=0.003),IKDC评分从术前30(22,35)分提高到100(95,100)分(Z=2.943,P=0.003)。结论关节镜下高强度缝线固定治疗儿童及青少年TSAF临床疗效满意,具有损伤小、复位好、固定牢固可靠、利于早期康复、不需要二次手术等优点,是治疗该骨折的有效方法。Objective To explore the clinical efficacy of arthroscopic high-strength suture fixation in the treatment of tibial eminence fractures in children.Methods A retrospective analysis was conducted on 11 pediatric patients with tibial eminence fractures treated at our hospital from January 2020 to December 2022.There were6 males and 5 females,aged 8 to 14 years(mean:9 years).Fractures involved the left side in 5 cases and the right side in 6 cases.According to the Meyers-McKeever classification,there were 5 typeⅡfractures,4 typeⅢfractures,and2 typeⅣfractures.Regular follow-up examinations were conducted to observe fracture healing,knee joint mobility,and complications.The Lysholm knee scoring and IKDC scoring were used to evaluate knee joint functions.Results The follow-up period ranged from 5 to 28 months,with a mean of(17.7±8.8)months.All wounds healed in the first stage without complications such as infection.Radiographic examination confirmed fracture healing in all patients,with a healing time ranging from 9 to 14 weeks(mean:12.1 weeks).There was no redislocation,malunion,or nonunion.At the final follow-up,knee flexion was restricted in 2 cases(range:0°-110°).All patients had negative results by anterior drawer and Lachman tests,with no evidence of physeal injury on X-ray.No complication such as pain or stiffness was reported,and patients were able to perform daily activities and participate in sports.The Lysholm knee score improved from a preoperative median of 32(range:25-37)to 100(range:98-100)(Z=2.937,P=0.003),and the IKDC score improved from a preoperative median of 30(range:22-35)to 100(range:95-100)(Z=2.943,P=0.003).Conclusions Arthroscopic high-strength suture fixation is effective in treating tibial eminence fractures in children and adolescents,demonstrating satisfactory clinical outcomes.It offers advantages such as minimal trauma,good reduction,secure fixation and early recovery,eliminating the need for secondary surgeries.

关 键 词：关节镜 缝线 儿童 胫骨骨折 

分 类 号：R683.4[医药卫生—骨科学]