关节镜下复位可吸收空心钉内固定治疗胫骨髁间前嵴撕脱骨折

Absorbable screw internal fixation for treatment of tibial intercondylar eminence avulsion fracture under knee arthroscopy

目的探讨膝关节镜下复位可吸收空心钉内固定治疗胫骨髁间前嵴撕脱骨折的方法及临床效果。方法自2009-04—2013-04,共诊治21例胫骨髁间前嵴撕脱骨折,关节镜下骨折块复位后,采用1或2枚可吸收空心钉内固定。结果术后切口均一期愈合,无膝关节感染、神经血管损伤及下肢深静脉血栓形成等并发症发生。术后均获随访12-18个月,平均13.4个月。术后3个月2例出现膝关节僵硬,屈伸受限,予麻醉下推拿松解后恢复至屈伸5°-110°。术后1年Lachman试验、前抽屉试验均为阴性。X线片及MR示：骨折对位愈合良好。末次随访时Lysholm评分为（91.67±0.76）分,IKDC评分为（96.13±0.87）分,均较术前显著提高,差异有统计学意义（t=53.130,P〈0.001;t=105.236,P〈0.001）。患者均恢复正常运动及生活能力。结论膝关节镜下复位可吸收空心钉内固定治疗胫骨髁间前嵴撕脱骨折具有微创、痛苦小、内固定相对牢固、操作简便、便于早期功能锻炼、术后关节功能恢复好等优点,临床效果良好。

Objective To investigate the methods and clinical effects of absorbable screw internal fixation for treatment of tibial intercondylar eminence avulsion fracture under knee arthroscopy. Methods There were 21 cases of tibial intercondylar eminence avulsion fracture between 2009 April and 2013 April. One or two absorbable screws were used for internal fixation after arthroscopic reduction of fracture. Results All incisions were primary healing, there was no infection, nerve and vascular injury, deep venous thrombosis of lower extremity and other complications. All patients were followed up from 12 to 18 months, average 13.4 months. Two cases showed stiff knee and flexion restriction three months later, all recovered to 5° to 110° flexion after manipulation under anaesthesia. One year after operation the Lachman test and the anterior drawer test was negative. X-ray and MR showed fracture healed very well. At the last follow-up, Lysholm score was（91.67±0.76）, IKDC score was（96.13±0.87）, significantly improved after the operation, the difference was statistically significant（t =53.130, P 〈0.001; t =105.236, P〈 0.001）. All patients regained normal movement and had an individual＇s ability to live a regular life. Conclusion Absorbable screw internal fixation for treatment of tibial intercondylar eminence avulsion fracture under knee arthroscopy has advantages of minimally invasion, less pain, relative stablility, simple operation, early functional exercise, and good recovery of joint function after operation, and can get good clinical effect.