关节镜下缝线拴结法多点固定治疗胫骨髁间前棘骨折

MULTI-SPOT SUTURE FIXATION UNDER ARTHROSCOPE FOR TREATING TIBIAL INTERCONDYLAR ANTERIOR EMINENCE FRACTURE

目的探讨关节镜下缝线拴结法多点固定治疗胫骨髁间前棘骨折的手术方法及临床疗效。方法 2006年2月-2010年1月,收治15例胫骨髁间前棘骨折患者。男14例,女1例;年龄7～55岁,中位年龄33岁。致伤原因:交通事故伤9例,运动伤2例,摔伤4例。患者前抽屉试验、Lachman试验及轴移试验均为阳性。膝关节功能Lysholm评分为(64.7±1.3)分。骨折按Meyers-McKeever分型:Ⅱ型5例,Ⅲ型7例,Ⅳ型3例。急性损伤13例,陈旧性损伤2例。关节镜下骨折复位后,在前交叉韧带定位器引导下,经胫骨上段前内侧切口创建贯穿骨块的骨隧道(直径2 mm),利用18号金属腰穿针沿骨隧道将2号Ethibond缝线引入关节腔,将缝线关节内一端进行两两拴结或自拴结,收紧缝线另一端并于关节外相互打结固定。结果术后切口均Ⅰ期愈合,无感染、下肢深静脉血栓形成等并发症发生。15例均获随访,随访时间14～48个月,平均24.2个月。X线片检查示骨折均达骨性愈合,愈合时间2～4个月,平均3个月。术后6个月1例Lachman试验、前抽屉试验为阳性,余14例均为阴性;轴移试验均为阴性。膝关节活动度正常者13例,轻度活动受限者2例。术后6个月Lysholm评分为(95.1±2.1)分,与术前比较差异有统计学意义(t=43.020,P=0.000)。结论关节镜辅助下缝线拴结法多点固定治疗胫骨髁间前棘骨折,手术创伤小、固定可靠、手术操作简便、疗效确实。

Objective To explore the surgical method and effectiveness of multi-spot suture fixation under arthroscope in treating tibial intercondylar anterior eminence fracture.Methods Between February 2006 and January 2010,15 patients with tibial intercondylar anterior eminence fracture were treated with multi-spot suture fixation under arthroscope after fracture reduction.There were 14 males and 1 female with a median age of 33 years（range,7-55 years）.The injury causes were traffic accident in 9 cases,sport in 2 cases,and falling in 4 cases.The anterior drawer test,Lachman test,and pivot shift test in all the cases turned out to be positive.The Lysholm score was 64.7 ± 1.3.According to Meyers-McKeever classification,5 cases were classified as type II,7 cases as type III,and 3 cases as type IV.Of them,13 cases had fresh fracture and 2 cases had old fracture.Assisted with anterior cruciate ligament-aimer,bone tunnels（2 mm in diameter） were built through the fracture fragments after fracture reduction,through which Ethibond 2 polyester sutures were guided into the joint by No.18 spine needles;after knot of 2 sutures or knot of only 1 suture was made,the other ends of sutures were fastened together outside the joint.Results The incisions of all the cases healed by first intention with no complication of infection or deep venous thrombosis.Fifteen patients were followed up 14-48 months with an average of 24.2 months.The X-ray examination indicated fractures healed in all the cases at 2-4 months（mean,3 months）.At 6 months after operation,14 cases showed negative results of Lachman test and anterior drawer test but 1 case positive,while all the cases showed negative results in pivot shift test.The extension and flexion spheres of knee activity were normal in 13 cases and were limited in 2 cases.The Lysholm score was 95.1 ± 2.1,showing significant difference when compared with the preoperative score（t=43.020,P=0.000）.Conclusion Multi-spot suture fixation under arthroscope is an effective method with small invasion,reliable fixation,and simple operation for treating tibial intercondylar anterior eminence fracture.