关节镜下改良双股钢丝前后挤夹固定胫骨嵴撕脱骨折

Arthroscopic double strand wire fixation anteriorly and posteriorly to anterior cruciate ligament for tibial intercondylar eminence fracture

目的 探讨关节镜下采用双股钢丝前交叉韧带前后挤夹固定治疗胫骨嵴撕脱骨折的手术技术和临床效果.方法 2009年1月至2012年2月北京大学人民医院关节病诊疗中心收治膝关节胫骨嵴骨折12例,男4例,女8例,平均年龄10～50（19.5 ±10.0）岁,受伤时间4d～2年,均为Meyers-Mekeever分型Ⅱ型和Ⅲ型骨折.采用关节镜下改良双股钢丝前后挤夹固定治疗.术后功能锻炼,负重时伸直位支具固定4～6周.结果 所有病例均获得随访,平均时间15.6（6 ～30）个月.最终随访显示关节活动度恢复,关节稳定性良好.术后X摄片提示骨折复位好,全部病例骨折愈合,未发现钢丝断裂的病例.术后Lysholm评分和IKDC评分：优10例,良2例.本组术中未出现骨块碎裂、前交叉韧带损伤、血管神经损伤和感染等并发症.结论 关节镜下改良双股钢丝前后挤夹固定治疗胫骨嵴骨折,手术操作相对简单,不需要损伤前交叉韧带的实质部,复位固定牢固,可获得满意的疗效。

Objective To explore the clinical outcomes of arthroscopic double strand wire fixation anteriorly and posteriorly to anterior cruciate ligament （ACL） for tibial intercondylar eminence fracture.Methods From January 2009 to February 2012,12 patients with tibial intercondylar eminence fracture were selected.There were 4 males and 8 females with an average age of 19.5 ± 10 （10-50） years.Time from injury to operation was 4 days to 2 years.All cases belonged to Meyers-Mekeever type Ⅱ and type Ⅲ.Arthroscopic double strand wire compressive fixation was performed anteriorly and posteriorly to ACL.Other measures included postoperative rehabilitation and supports with brace in knee extension when weight-bearing for 4-6 weeks.Results The average follow-up period was 15.6 （6-30） months.Final clinical results showed good range of motion and good knee stability.On postoperative radiology,there were good reduction of intercondylar eminence fracture and excellent healing.There was no occurrence of wire rupture.Postoperative IKDC and Lysholm scores were excellent （n =10） and good （n =2）.There was no such complication as fragmentation of intercondylar eminence fracture bone,neurovascular injury or infection.Conclusion Arthroscopic double strand compressive fixation for tibial intercondylar eminence fracture may be easily performed without injury to ACL substance.The reduction is both stable and reliable.And the clinical outcome is excellent.