带线锚钉复合双滑轮技术治疗累及外侧半月板前根的前交叉韧带胫骨止点撕脱骨折  

Treatment of anterior cruciate ligament tibial avulsion fracture involving anterior root of lateral meniscus with wire anchor nailing composite double pulley technique

作　　者：杨昆明 王新民 王寒 刘国帅 李冰 白玉玺 刘飞 YANG Kunming;WANG Xinmin;WANG Han;LIU Guoshuai;LI Bing;BAI Yuxi;LIU Fei(No.2 Department of Orthopaedics,the First Hospital of Qinhuangdao,Hebei Medical University,Qinhuangdao Hebei,066000,P.R.China)

机构地区：[1]河北医科大学附属秦皇岛市第一医院骨二科,河北秦皇岛066000

出　　处：《中国修复重建外科杂志》2025年第4期440-445,共6页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨膝关节镜下带线锚钉复合双滑轮技术治疗累及外侧半月板(lateral meniscus,LM)前根的前交叉韧带(anterior cruciate ligament,ACL)胫骨止点撕脱骨折的临床疗效。方法回顾分析2019年1月—2023年9月收治且符合选择标准的35例累及LM前根的ACL胫骨止点撕脱骨折患者临床资料。男20例,女15例;年龄10~57岁,平均29岁。受伤至手术时间3~20 d,平均9.6 d。Meyers-McKeever分型:Ⅱ型5例,Ⅲ型12例,Ⅳ型18例。术前膝关节前部不稳Lachman试验和前抽屉试验均为阳性。采用膝关节镜下带线锚钉复合双滑轮技术固定LM前根以及撕脱骨折块。术后复查X线片评估骨折愈合情况;术前及末次随访时使用前抽屉试验及Lachman试验评估膝关节稳定性,KT-2000测量仪测量膝关节前向松弛度,Lysholm评分、国际膝关节文献委员会(IKDC)评分评估膝关节功能;末次随访时使用McMurry试验、膝关节过伸试验评估半月板恢复情况。结果所有患者手术均顺利完成,手术时间56~78 min,平均67.6 min;术中无神经、血管损伤等发生。35例均获随访,随访时间12~18个月,平均15.1个月。随访期间未出现感染、膝关节僵硬、内固定物松动、骨折移位以及再骨折等情况。骨折均愈合,临床愈合时间8~15周,平均10.9周。末次随访时,4例患者前抽屉试验、Lachman试验弱阳性,余均为阴性;McMurry试验、膝关节过伸试验均为阴性;未出现患者诉伸膝疼痛或伸直障碍,所有患者均恢复至正常生活或体育、劳动;16例骨骺未闭合患者均未出现任何骨骺损伤、生长发育障碍。末次随访时Lysholm评分、IKDC评分及KT-2000膝关节前向松弛度均较术前明显改善,差异有统计学意义(P<0.05)。结论带线锚钉复合双滑轮技术治疗累及LM前根的ACL胫骨止点撕脱骨折,在固定撕脱骨折块的同时可有效固定LM前根,较好地恢复了膝关节功能和稳定性。Objective To investigate the effectiveness of knee arthroscopy with wire anchor nailing composite double pulley technique in the treatment of anterior cruciate ligament(ACL)tibial avulsion fracture involving the anterior root of the lateral meniscus(LM).Methods Clinical data of 35 patients with ACL tibial avulsion fracture involving the anterior root of the LM admitted between January 2019 and September 2023 and met the selection criteria were retrospectively analysed.There were 20 males and 15 females;ages ranged from 10 to 57 years,with a mean of 29 years.The time from injury to surgery ranged from 3 to 20 days,with a mean of 9.6 days.Meyers-McKeever classification included 5 cases of typeⅡ,12 cases of typeⅢ,and 18 cases of typeⅣ.Preoperative anterior knee instability Lachman test and anterior drawer test were positive.The anterior root of the LM as well as the avulsion fracture block were fixed using suture anchor nails compounded with double pulley technique under arthroscopy.Postoperative X-ray films were performed to assess fracture healing;knee stability was assessed using the anterior drawer test and Lachman test,anterior laxity of the knee was measured by KT-2000,and knee function was assessed using the Lysholm score and the International Knee Documentation Committee(IKDC)score;at last follow-up,the recovery of the meniscus was assessed using the McMurry test and knee hyperextension test.Results All the patients were successfully operated,the operation time ranged from 56 to 78 minutes,with an average of 67.6 minutes,and there was no nerve or blood vessel injury during operation.Thirty-five cases were followed up 12-18 months with an average of 15.1 months.During the follow-up,there was no infection,knee stiffness,loosening of internal fixation,fracture displacement,or re-fracture.The fractures all healed,with a clinical healing time of 8-15 weeks,averaging 10.9 weeks.At last follow-up,4 patients had weakly positive anterior drawer test and Lachman test,and the rest were negative;McMurry test and k

关 键 词：带线锚钉 外侧半月板前根 前交叉韧带胫骨止点 撕脱骨折 关节镜 

分 类 号：R687.3[医药卫生—骨科学]