关节镜下治疗胫骨髁间棘骨折方式的选择及术后疗效分析

Surgical procedures of tibial spine fractures under arthroscope and postoperative effectiveness

目的 探讨分析膝关节镜下治疗胫骨髁间棘骨折的方式选择及对比分析不同内固定方式的术后疗效.方法 回顾性分析2009年9月至2013年6月期间行膝关节镜下内固定治疗的胫骨髁间棘骨折的56例患者的临床资料.其中Orthocord缝线固定组21例、钢丝固定组19例、螺钉固定组16例.术前与术后膝关节功能评价均采用Lysholm评分.结果 56例患者均获得随访,随访时间12～26个月,平均21个月.三组患者术前及术后平均Lysholm评分差异无统计学意义（P＞0.05）,术后Lysholm评分较术前明显提高（P＜0.05）.膝关节X线片显示骨折完全愈合.其中3例出现前交叉韧带小部分断裂损伤,经关节镜治疗后取得满意恢复效果.结论 膝关节镜辅助下内固定治疗胫骨髁间棘骨折创伤小、固定牢靠,根据具体情况选择相应的固定方式,术后可早期活动,使关节功能得到最大程度恢复,是值得肯定的有效治疗方式.

Objective To explore the surgical procedures of tibial spine fractures under the knee arthroscopy and postoperative results of different internal fixations.Methods We retrospectively analyzed 56 cases of tibial spine fractures treated by the knee arthroscopy from Sep.2009 to Jun.2013.Three groups were set up,including Orthocord fixation group （n =21）,steel wire fixation group （n =19）,and screw fixation group （n =16）.The knee function was assessed by the preoperative and postoperative Lysholm scores.Results All the patients were followed up for 12 to 26 months （mean 21 months）.There was no statistically significant difference among the three groups in preoperative and postoperative Lysholm scores （P＞0.05）.The average postoperative Lysholm scores were obviously increased as compared with those before operation （P＜0.05）.The knee X ray revealed satisfactory reduction and union of the fractures.But 3 cases suffered from small parts of anterior cruciate ligament damage and satisfactory results were obtained after arthroscopic treatment.Conclusion Knee arthroscopy-aided internal fixation for tibial spine fractures is effective with less trauma and reliable fixation.Choosing the right fixation can improve joint function and recovery activities at early time.