关节镜下空心钉内固定治疗胫骨髁间棘骨折的疗效分析

Internal fixation of tibial intercondylar eminence fracture with cannulated screws under the overview of arthroscopy

目的探讨关节镜直视下空心钉内固定在治疗胫骨髁间棘骨折临床疗效中的作用。方法对30例胫骨髁间棘骨折患者在关节镜下行空心钉治疗。同时直视下检查韧带与半月板的损伤情况,并予以治疗。结果 30例胫骨髁间棘骨折,Megers和Mckeever分型Ⅱ16例,Ⅲ14例。术中发现合并前交叉韧带损伤14例,合并内侧副韧带损伤7例,合并外侧半月板损伤9例。经临床随访26例,平均随访时间为23.6个月,膝关节活动度按Lysholm标准评定,优良率为89%。术后6个月X线检查骨折愈合良好,无膝关节内外畸形、创伤性关节炎、膝关节不稳及跛行。患者满意率为83.3%。结论关节镜下空心钉治疗胫骨髁间棘骨折既可复位关节内软骨面,减少关节炎的发生,又能在直视下探查和治疗膝关节内韧带和半月板的损伤情况,预防膝关节不稳等并发症的发生。

Objective To investigate the role of clinical efficacy with cannulated screw fixation under direct vision of arthroscopy in the treatment of tibial fractures.Methods Thirty tibial intercondylar eminence fracture patients were treated with cannulated screw under arthroscopy.During the arthroscopic procedure,articular surface was restored to achieve the basic level and the shift was less than 2mm,then cannulated screw was fixed.At the same time,the ligament and meniscus injury were checked under direct vision.Results Thirty cases with tibial intercondylar eminence fracture,accounting to Megers and Mckeever,16 cases were type Ⅱ,14 cases were type Ⅲ.Combined ACL injury was observed in 14 cases,MCL injury was observed in 7 cases,meniscus injury was detected in 9 cases.Twenty-six cases were followed-up,the average follow-up time was 23.6 months.According to Lysholm knee assessment standards,the excellent rate was 89%.X-ray examination showed that the fracture healed well in 6 mouths post-operation.There were no complications,such as varus and valgus knee deformity,traumatic arthritis,and knee instability.Patient’s satisfaction rate was 83.3%.Conclusion Arthroscopy combined with cannulated screw is used to treated tibial condylar fracture.This procedure has many advantages,which can reset the articular cartilage surface,reduce the incidence of arthritis,detect and treat knee ligament and meniscus injury to prevent the occurrence of knee instability.