不同手术方法治疗胫骨髁间棘撕脱骨折的临床疗效分析

A study of three different procedures for avuision fracture of tibial intercondylar eminence

目的观察不同手术方法治疗胫骨髁间棘撕脱骨折的疗效。方法1995年10月至2005年10月应用3种手术方法治疗胫骨髁间棘撕脱骨折患者49例：切开复位内固定17例（A组）；关节镜下复位内固定19例（B组）；有限切开加关节镜辅助复位内固定13例（C组）。平均随访时间4．6年。结果A、B、C3组伸膝功能正常分别为35．5％、16．0％和38．0％；轻度异常分别为35．5％、11．0％和23．0％；中度异常29．0％、47．0％和31．0％；重度异常0、26．0％和8．0％。3组屈膝正常分别为82．0％、78．0％和84．0％；轻度异常12．0％、11．0％和8．0％；中度异常6．0％、11．0％和8．0％。Lachman和前抽屉试验阳性率3组分别为35．0％、45．0％和38．0％，轴移试验阳性率3组分别为11．0％、16．0％和13．0％。Lysholm评分3组平均分别为98．6分、97．3分和98．2分；Tegner评分分别为6．6分、6．4分和6．7分，KT-2000检查胫骨前移分别平均为6．9mm、7．1mm和6．6mm；健患侧对比差异分别平均为1．4mm、1．7mm和1．5mm，除伸膝功能A组与B组比较差异有统计学意义外（P=0．02，P〈0．05），其他各种指标组间比较均无显著统计学意义（P〉0．05）。结论有限切开辅助关节镜下适当的过度复位和三维、坚强内固定是治疗胫骨髁间棘撕脱骨折较为理想的方法。

Objective To observe the clinical outcomes and differences among three surgical procedures for avulsion fracture of tibial intercondylar eminence. Methods From October 1995 to October 2005, 3 different procedures had been performed on 49 patients, which included open reduction and internal fixation （ Group A, n = 17 ）, arthroscopic reduction and internal fixation（ Group B, n = 19） and limited open reduction and internal fixation assisted with arthroscopy （ Group C, n = 13 ）. All patients were followed up for 1 to 10 years （ average 4. 6 years）. Results For the 3 groups, normal extension function were 35.5%, 16.0% and 38.0%, mild abnormal 35.5% ,11.0% and 23.0%, moderate abnormal 29. 0% ,47.0% and 31.0%; and severe abnormal were 0, 26.0% and 8.0%. Normal flexion were 82.0%, 78.0% and 84.0%, mild abnormal 12.0% ,11.0% and 8.0%, moderate abnormal 6.0% ,11.0% and 8.0%. The positive rate of Lachman＇s or anterior drawer test were 35.0% ,45.0% and 38.0% ; McIntoshi test were 11.0%, 16.0% and 13.0% respectively for 3 groups. Lysholm＇ scale were average 98. 6,97.3 and 98.2 ; Tegner＇ scale were 6. 6, 6. 4 and 6. 7. KT-2000 showed that anterior translation of tibial were 6. 9,7.1 and 6. 6mm;side to side difference were 11.4,1.7 and 1.5 mm, except that statistically significant differences were found in extension function between group A and group B （ P = 0.02 ）. There were no any statistically significant differences in other aspects. Conclusion Limited open and properly over reduction and three dimensional as well as strong internal fixation assisted with arthroscopy should been attempted for the treatment of avulsion fracture of tibial intercondylar eminence.