关节镜下跨骺板8字缝线固定法治疗前交叉韧带胫骨止点撕脱骨折后的随访研究

Arthroscopic figure-of-eight suture fixation in the anterior cruciate ligament avulsion fractures of tibia

目的探讨关节镜下治疗骨骺未成熟患儿前交叉韧带胫骨止点撕脱骨折的临床效果,并评估该方法对骺板的影响。方法对2003年1月～2005年9月收治的25例骨骺未成熟患儿前交叉韧带胫骨止点撕脱骨折的病例资料进行回顾性分析。按Meyers-McKeever-Zaricznyj骨折分型:Ⅱ型7例,Ⅲ型16例,Ⅳ型2例。均采用关节镜下跨骺板8字缝线法固定。术后予股四头肌、腘绳肌等长收缩锻炼,主动伸屈关节,髌骨内推锻炼。采用通讯随访和门诊随访两种方法,依据膝关节IKDC,Lysholm,Tegner评分评价疗效。门诊随访患儿通过双膝正侧位X线片,对比测量双小腿长度有无差异、胫骨近端骺板愈合是否有异常,以评价该手术是否会造成生长抑制。结果随访12～44个月(平均28个月),其中12例获门诊随访,10例获通信随访,3例失访。最后随访时,所有22例患儿恢复患侧活动度。门诊随访者Lysholm评分平均为(98.58±2.23)分,Tegner运动能力评价平均为(6.75±0.45)分,IKDC主观评价平均为(95.25±6.34)分,客观评价10例A、2例B。KT-1000检查10例正常(双侧差异<3mm),1例接近正常(双侧差异为3mm),1例异常(双侧差异5mm)。随访结束双侧下肢长度无差别无畸形,双膝X线片对比未见骨骺过早闭合征象。通信随访者Lysholm评分平均为(98.5±2.41)分,IKDC主观评价平均为(96.00±2.75)分。Tegner运动能力评价平均为(6.90±0.32)分。随访结束双侧下肢长度无差别无畸形。结论关节镜下跨骺板8字缝线固定法具有创伤小、固定可靠、适宜早期功能锻炼、术后恢复快、避免二次手术、并发症少等优点,同时可以一并处理关节内合并损伤。并且不会造成生长板抑制。

Objective To evaluate the outcome of the arthroscopic treatment of the avulsion fractures of tibia in children. Methods From January 2003 to September 2005,25 patients with avulsion fracture of tibia were managed our institution. The clinical outcomes were analyzed. According to Meyers-McKeever-Zaricznyj classification systems, there were seven type Ⅱ, sixteen type Ⅲ, and two type Ⅳ injuries. The patients were treated with arthroscopic figure-of-eight suture fixation. Post-operatively, the patients were encouraged to do rehabilitation exercise. The patients were followed up in out-patient department or by postal questionnaires. The clinical results were evaluated according to IK-DC subjective score,Lysholm and Tegner rating scales. The growth was evaluated by physical examining of both lower limbs and X-ray examination. Results Twenty-two patients were followed up for 28 months （12 to 44 months）, 12 patients were assessed in the out-patient department, 10 by postal questionnaires and 3 were lost in the follow-up. At the last follow-up,all affected knees regained full range of motion. Functional assessment revealed excellent results. For the 12 patients followed up in the outpatient department, the Lysholm score was 98. 58 ± 2. 23, IKDC subjective score was 95. 25 ± 6. 34, and Tegner score was 6. 75 ± 0. 45. The objective assessment was A in 10 and B in 2 patients. For the 10 patients assessed by postal questiormaires,Lysholm score was 98. 5 ± 2. 41 ,IKDC subjective score was 96. 0 ± 2.75, and Tegner score was 6. 9 ± 0. 32. No patient suffered from epiphyseal growth plate abnormality. Conclusions Arthroscopic figure-of-eight suture fixation for the anterior cruciate ligament avulsion fractures of tibia in children has several advantages including minimal invasion, early mobilization,and quick recovery. Moreover it does not affect the epiphyseal plate growth.