关节镜下利用可吸收螺钉和orthocord线治疗前交叉韧带止点撕脱性骨折的临床观察

Arthroscopic treatment of tibial intercondylar eminence avulsion fractures using absorbable screws and orthocord thread fixation

目的观察关节镜下在腰穿针引导下利用可吸收螺钉和orthocord线治疗前交叉韧带止点撕脱性骨折的疗效。方法 2009年1月至2013年1月,关节镜下在腰穿针引导下利用可吸收螺钉和orthocord线治疗成人前交叉韧带止点撕脱性骨折30例,按Meyers-McKeever分型:II型9例,III型16例,IV型5例。手术在关节镜下进行,复位骨折后,先采用可吸收螺钉固定,再采用交叉韧带重建钻导器(Acufex PCL guide)引导,由关节外向关节内骨折块边缘钻孔制成两骨髓道,置入腰穿针后通过腰穿针穿线固定骨折块。术后不需要石膏外固定,鼓励患者主动伸屈关节,进行股四头肌、腘绳肌等长收缩锻炼及髌骨推移锻炼。随访时拍摄X光片并采用Lysholm膝关节功能评分标准来评定疗效。结果所有患者术后均恢复良好,无膝关节不稳,平均愈合时间(7.0±0.6)周。术后Lysholm膝关节评分(92.3±1.6)分,术后6个月评分(97.6±1.7)分,与术前(74.6±4.3)分比较差异均有统计学意义(P<0.05)。结论关节镜下复位联合可吸收螺钉和orthocord线固定治疗前交叉韧带下止点撕脱性骨折固定可靠、手术创伤小,术后不需石膏固定,不需要二次手术取出内固定,术后功能恢复良好。

Objective To introduce a new surgical skill and the clinical outcomes of arthroscopic treatment of tibial intercondylar eminence avulsion fractures using absorbable screws and orthocord suture fixation. Methods From 2009 to 2013, 30 cases of tibial eminence avulsion were treated with this new surgical skill. The patients were divided by using Meyers-McKeever method into 3 types： type Ⅱ （9 cases） , type Ⅲ（ 16 cases） , and type Ⅳ （5 cases）. Surgery was performed under the arthroscopy. First, bone fractures were repositioned and fixed up with absorbable screws. Then, Acufex PCL guide was used as a guide to make 2 bone marrow canals on the edge of fractured bone from extra-articular to intra-articular sections of the bone, and then sections of the fractured bone was fixed up. Plaster cast was not necessary after surgery, and the patients were encouraged to extend the affected knee voluntarily. Regular plain anteroposterior and lateral X-ray films were taken to detect bone healing of avulsed fragment. Lysholm scoring scale system was used to assess knee function and therapeutic effect of surgery. Results All the patients recovered quite well, with no signs of instable knee joint. Average healing time was （7.0 ± 0.6） weeks. All the 30 patients had medical follow-ups for as long as 10 months to 3 years, and the average follow-up time was （ 18 ± 4.5 ） months. All patients recovered well after operation without knee instability. Lysholm knee scores after surgery were （92.3 ± 1.6） , and Lysholm knee scores 6 months after surgery were （ 97.6 ± 1.7 ）. Statistical differences could be noted in the scores, when they were compared with those before surgery （74.6 ± 4.3 ） （ P 〈 0.05 ）. Conclusion Bone reposition under arthroscopy combined with absorbable screws and orthocord suture fixation in the treatment of tibial intercondylar eminence avulsion fracture was reliable and minimally invasive. Furthermore, plaster cast was not necessary after surgery and second surgery was not required to remove the fixation, and the function of the affected knee joint could recover quite well.