关节镜下前交叉韧带胫骨止点浅表撕脱骨折的“十”字缝合固定

Arthroscopic “ 十 ” shaped suture fixation for the avulsion fracture of inter condylar eminence of anterior cruciate ligament from the tibial

目的 探讨在关节镜下运用“十”字缝合方法治疗前交叉韧带胫骨止点浅表撕脱骨折的手术方法和要点。方法 2008年10月-2012年08月笔者所在医院应用关节镜下“十”字缝合固定前交叉韧带胫骨止点部浅表撕脱骨折16例,所有患者在关节镜下用5-0爱惜帮缝线“十”字穿过腱骨联合区,在胫骨内侧骨桥上打结固定。关节镜标准内、外侧入路监视复位,屈膝90-110＆#176;,以前交叉定位器械在浅表撕脱的骨皮质下方的胫骨骨面的呈“十”字形顶点上分别以2。0 mm克氏针钻孔备用,以肩关节镜下的一次性缝合锁分别平行撕脱骨片的矢状轴和冠状轴“十”字交叉穿过骨片上方的韧带实质部,并带入爱惜帮缝线,分别标志好后经过置于膝关节内外侧入口通道引出关节外,再经先前钻好的胫骨骨孔内引0。8 mm的双股不锈钢钢丝至膝关节外侧,在膝关节外侧将对应的缝线套入钢丝内,依次引出胫骨骨孔。关节镜监视下以探勾给予骨片解剖复位,在胫骨外侧骨皮质上拉紧交叉打结,使韧带撕脱骨片稍有下陷,使前交叉韧带完全恢复张力。术后支具保护下进行适当范围的关节活动训练。结果 术后经平均随访6-33个月,门诊X线片提示骨性愈合时间在术后2。5 -4。0个月,随访末次的改良Lys holm评分：优13例、良2例、可1例、差0例。近期优良率93。7％。结论 关节镜下运用“十”字缝合方法治疗前交叉韧带胫骨止点浅表撕脱骨折具有创伤小、复位固定可靠、恢复快、并发症少等优点。

Objective To explore the operating methods and key points in ＂十＂ shaped suture repeating avulsion fractures of anterior cruciate ligament （ACL） under arthroscopy. Methods From October 2008 to August 2012,16 patients with cruciate ligament tibial avulsion fractures were treated with non absorbable suture fixation method. First,the combined injuries were treated,then two tibial tunnels were drilled in the center of the avulsed site using ACL guide. Double strands NO. 5 polyester sutures were passed through the body of ACL using a suture lock with steel wire,then the sutures ends were pulled out through the two tibial bone tunnels. Finally the avulsion fracture fragment was fixed by tying the sutures. Postoperative management was early exercise and delayed weight bearing. Results All of 16 patients were followed-up for mean duration of 10.5 months. The X-ray suggested bone healed about 2.5-4 months after operation. The outcome was excellent in 13 cases, good in 2 and fair in 1 according to the advanced,Lyshdm＇s classification at the last of follow up. The excellent and good rate was 93.7%. Conclusion The above technique needn＇t traditional cut, and has many advantages such as mini- injury, rapid recovery, and less complication, etc.