Segond骨折合并前交叉韧带损伤的外科治疗

Surgical treatment of Segond fracture combined with anterior cruciate ligament injury

目的探讨Segond骨折合并前交叉韧带（anterior cruciate ligament，ACL）损伤的致伤机制、临床特点和外科治疗方法。方法选择2008年1月-2010年12月收治的9例Segond骨折合并ACL损伤的患者，关节镜下均可见ACL断裂及内侧副韧带（medial collateral ligament，MCL）断裂，1例还合并外侧副韧带（1ateral collateral ligament，LCL）断裂、内侧半月板损伤，4例合并内侧半月板撕裂，2例合并外侧半月板撕裂。均行关节镜下异体肌腱移植、ACL重建、内侧副韧带修补术。1例同时行LCL重建术，3例行半月板缝合术，4例行半月板成形术。6例Segond骨折块较大，分别以2枚空心拉力螺钉固定，3例骨折块较小，以1枚空心拉力螺钉固定。结果平均随访12个月。Lysholm术后评分平均为59分，疗效均满意。结论Segond骨折常伴有ACL损伤，前者对后者有很好的提示作用。在重建ACL的同时，对于Segond骨折块较大者应予复位、固定，对于合并的损伤，也应同期手术治疗。

Objective To investigate the injury mechanism, clinical characteristics and surgical treatments of Segond fracture combined with anterior cruciate ligament （ACL） injury. Methods Nine patients suffering from Segond fracture combined with ACL injury were treated between January 2008 and December 2010. All the patients revealed ACL and medial collateral ligament （MCL） breakage under ar- throscopy. Furthermore, one patient was associated with lateral collateral ligament （LCL） breakage and medial meniscus injury, four with medial meniscus tear and two with lateral meniscus tear. All the pa- tients underwent arthroscopic tendon allotransplantation, ACL reconstruction and MCL repair. Besides, synchronous LCL reconstruction was performed in one patient, meniscus suture in three and meniscus plasty in four. Six patients with large Segond fracture fragments were fixed with two hollow lag crews and three with relatively small fracture fragments fixed with one hollow lag crew. Results The mean follow- up period was 12 months, which showed average postoperative Lysholm score of 59 points and satisfactory clinical outcome. Conclusions Segond fracture is often combined with ACL injury and is predictive for ACL injury. In ACL reconstruction, large Segond fracture blocks should be reduced and fixed and the combined injuries also should be treated in the same period.