关节镜下撬拨复位空芯松质骨螺钉内固定治疗儿童前交叉韧带胫骨止点撕脱骨折

Internal Fixation of Avulsion Fracture at Tibial Insertion of ACL in Children through Percutaneous Reduction by Leverage Using Hollow Cancellous Bone Screw under Arthroscope

目的:探讨关节镜监视下撬拨复位与空芯松质骨螺钉内固定治疗儿童前交叉韧带胫骨止点撕脱骨折的方法与疗效。方法:2002年12月～2007年12月,采用关节镜监视下撬拨复位和钛合金空芯松质骨螺钉内固定法,治疗儿童前交叉韧带胫骨止点撕脱骨折68例,其中女29例,男39例;年龄6～15岁,平均12岁;Ⅱ型(伴患膝伸直受限)22例,Ⅲ型46例;均采用钛合金空芯松质骨螺钉内固定。结果:术后获得随访68例,平均18个月(12～36个月)。术后KT-2000测量显示,与健侧比较,患侧前交叉韧带张力基本恢复,X线片显示骨折块复位好,内固定牢靠,骨折愈合,膝关节稳定,Lachman和抽屉试验阴性。无肿胀、疼痛和膝关节功能障碍,无髁间窝撞击征表现,术后功能恢复满意;术后未发现患者出现伤肢成角与短缩等发育异常。结论:关节镜视下撬拨复位和钛合金空芯松质骨镙钉内固定治疗儿童前交叉韧带胫骨止点Ⅱ型(伴患膝伸直受限)、Ⅲ型撕脱骨折,复位准确,固定可靠,能有效地避免手术所致的骨骺再次损伤,有利于功能恢复。

Objective To introduce the technique and efficacy of the treatment of avulsion fracture at tibial insertion of anterior cruciate ligament（ACL） in children through internal fixation by hollow cancellous bone screw under arthroscope. Methods December 2002 -December 2007, internal fixation using percutaneous reduction by leverage was conducted in 68 children with avulsion fracture at tibial insertion of ACL in our hospital. In 68 children, there were 29 females and 39 males, aged 6-15 years（average age of 12 years）, including 22 cases of type Ⅱ （with limited knee extension） and 46 cases of type Ⅲ. The fracture was fixed by hollow titanium cancellous bone screw. Results Sixty eight cases were followed up for an average of 18 months（12-36 months）. The muscle tension （mea sured by KT-2000） in injured side was recovered close to the uninjured side. Excellent reduction, solid internal fixation, complete healing, stable knee joint and negative Lachman and drawer tests were shown in this clinical setting. No swelling, pain and knee dysfunction were found. Impingement sign at intercondylar fossa disappeared. The patients were satisfied with their functional recovery. There was no abnormal angulation and shortness. Conclusion Treatment of avulsion fracture （type Ⅱ with limited knee extension or type Ⅲ ） at tibial insertion of ACL by arthroscopie internal fixation with hollow titanium alloy cancellous bone screw could obtain accurate and reliable reduction, and avoide epiphysis injury with satisfactory functional recovery.