关节镜下治疗前交叉韧带胫骨髁间嵴撕脱骨折

Arthroscopic treatment of anterior cruciate ligament tibial intercondylar eminence avulsion fracture

目的探讨关节镜下对前交叉韧带胫骨髁间嵴撕脱骨折应用缝合线加钢缆进行复位和内固定的疗效。方法 56例前交叉韧带胫骨髁间嵴撕脱骨折患者(Ⅱ型13例,ⅢA型15例,ⅢB型13例,Ⅳ型15例),关节镜下应用Ethibond X519缝合线加钢缆对胫骨髁间嵴撕脱骨折区进行缝合捆绑,通过胫骨髁前置双隧道牵引复位、固定。结果术后X线片显示胫骨嵴撕脱骨折完全复位。56例均获随访,时间18～21个月。末次随访时骨折完全愈合。Lachmen试验(-)56例;前抽屉试验(-)55例,1例弱阳性。IKDC评定:术前C级30例,D级26例;术后A级55例,B级1例。Lysholm评分:术前37～52(42.7±0.34)分;术后91～96(95.7±0.56)分,平均提高53.0分±0.43分,术前、术后比较差异有统计学意义(P<0.01)。结论关节镜下应用缝合线加钢缆内固定治疗膝关节前交叉韧带胫骨髁间嵴撕脱骨折,可以对移位的撕脱骨折很好地复位,最大限度地加大单位面积上的压力,增加刚性稳定。并可早期功能锻炼。

Objective To study the effect of arthroscopic treatment of anterior cruciate ligament tibia1 intercondylar eminence avulsion fracture with suture and cable reduction and internal fixation. Methods 56 cases of anterior cruci- ate ligament tibial intereondylar eminence avulsion fracture were recruited, including Meyers and McKeever type Ⅱ 13 cases; type Ⅲ 15 cases; type Ⅲ 13 cases;and type ⅣV 15. With Ethibond X519 suture plus cable, the tibial eminence fractures were arthroscopie treated by reduction and fixation by suture zones bound through the front double- tibial tunnel traction. Results X-ray film showed tibial avulsion fractures got complete reduction. 56 patients were followed up for 18 -21 months. In the final follow-up, all got completely healed. Lachmen test was 56 （ - ） , anterior drawer test was 55 （ - ）, with 1 weakly positive. With IKDC evaluation, it was C in 30 cases and D in 26; After op- eration, it was A in 55 cases, and B in 1. Lysholm scores were 37 -52（42. 7 ±0. 34） before surgery, and 91 -96 （ 95.7± 0. 56） after operation, with 53.0 -0.43 improvement （ P 〈 0. 01 ）. Conclusions The anterior cruciate liga- ment tibial intercondylar eminence avulsion fracture can be treated by reduction and fixation by suture zones bound through the front double-tibial tunnel traction, which provides good reduction and fixation. The per unit area pressure can be maximized, with which the rigidity and stability is increased. Early exercises can be permitted.