关节镜下ExtremiFix空心双头加压螺钉治疗成人胫骨髁间隆突骨折

Arthroscopic Internal Fixation by ExtremiFix Cannulated Screw for Tibial Eminence Fractures

目的观察关节镜下ExtremiFix空心双头加压螺钉(ExtremiFix cannulated screw system)治疗成人胫骨髁间隆突骨折的临床疗效。方法 2010年6月～2012年3月,对14例Meyers-McKeever分型Ⅱ型、Ⅲ型胫骨髁间隆突骨折的成人患者采用关节镜下复位、ExtremiFix非埋头型空心双头加压螺钉内固定,术后辅以铰链膝支具外固定并功能锻炼。结果全部病例术后经X线片检查证实骨折良好复位,随访6～21个月,平均13个月,均达到骨性愈合且骨折未移位。膝关节自主活动良好,无关节松弛。末次随访,Lysholm膝关节评分93.8～98.1分,平均96.2分,未出现手术并发症,无螺钉松动。结论关节镜下复位、ExtremiFix空心双头加压螺钉内固定治疗Meyers-McKeeverⅡ、Ⅲ型成人髁间隆突骨折具有微创、螺钉双向加压作用能使骨折早期可靠固定且不占用关节空间等优势,更利于膝关节功能的恢复,为临床提供了另一种简单、有效的手术方法。

Objective To observe the efficacy of ExtremiFix cannulated screw fixation by arthroscopy for adult tibial eminence fractures. Methods Clinical data of 14 adult patients with tibial eminence fracture （ Meyers-McKeever sub-type Ⅱ and Ⅲ ） , who received arthroscopic reduction and fixation with ExtremiFix cannulated screw were analyzed. External fixation with hinged knee orthosis and functional exercises were carried out postoperatively. Results X-ray confirmed that all the patients had an excellent recovery postoperatively with the fractured bone healing without displacement during a 6- to 21-month follow-up （mean：13 months） ; excellent knee motion without joint laxity were achieved in all the cases. At the last follow-up visit, the Lysholm knee scale was 93.8 - 98.1 points （mean ：96.2 points）, and no obvious surgical complications or screw loosing were found. Conclusions Arthroscopic restoration and fixation with ExtremiFix cannulated screw is effective for tibial eminence fractures （ Meyers-McKeever sub-type Ⅱ and Ⅲ ） in adult patients. We recommend it as a simple and effective therapy, for it is minimally invasive and bidirectional compressive screws provide an earlier reliable fixation without taking the joint space.