可吸收软骨钉内固定治疗儿童胫骨髁间嵴骨折的疗效观察

Efficacy of absorbable cartilage screws internal fixation in treatment of tibial intercondylar eminence fracture in children

目的：探讨自身增强可吸收软骨钉内固定治疗儿童胫骨髁间嵴骨折的临床疗效。方法：2007年03月至2014年03月共收治41例儿童胫骨髁间嵴骨折患者,男27例,女14例,平均年龄10.4岁（6-14岁）。骨折按Meyers-Mc Keever分型：Ⅱ型15例,Ⅲ型18例,Ⅳ型8例。受伤至手术时间2-7 d（平均3.8 d）。采用关节镜下行骨折复位及可吸收软骨钉内固定治疗19例,切开复位骨折及可吸收软骨钉内固定治疗22例。术后均采取长腿支具固定4-6周,定期复查X片,按照Lysholm评分评定疗效。结果：41例患儿均获得12-48个月随访,平均24个月,术后切口均Ⅰ期愈合,无骨折再移位和骨不连发生。骨折愈合时间为6-12周,平均7.9周。术后3个月时有2例出现膝关节僵硬,屈伸受限,予以CPM机器功能锻炼和理疗后,膝关节活动度恢复至5°-120°。术后6个月时,有6例仍有屈膝受限,但受限均小于10°,且对日常活动无影响。Lysholm评分优33例,良6例,可2例,差0例,优良率95.12%。术前的Lysholm评分平均为（46.1±3.2）分,末次随访时评分平均为（95.5±1.2）分,前后配对t检验,差异有统计学意义（t=58.7,P=0.000）。结论：可吸收软骨钉内固定治疗儿童胫骨髁问嵴骨折具有固定确切,操作简单,对骺板损伤小,术后膝关节功能恢复快,避免了二期手术取出内固定等优点,是一种值得推广的比较理想的内固定方法。

Objective：To discuss the efficacy of absorbable cartilage screws internal fixation in treatment of tibial intercondylar eminence fracture in children. Methods：From March 2007 to March 2014,41 pediatric cases（male 27,female 14） with an average age of10.4 years（range from 6 to 14 years） who suffered tibial intercondylar eminence fracture underwent surgery treatment. According to the modified classification of Meyers and Mc Keever,there were 15 type Ⅱ,18 type Ⅲ,and 8 type Ⅳ fractures. All of these patients received the operation between 2 d and 7 d with an average of 3.8 d. Among them,19 cases were treated by absorbable cartilage screws under arthroscopy and the other 22 cases were treated with open reduction and internal using absorbable cartilage screws.Brace external fixation were carried out postoperatively at 4-6 weeks;X-ray was rechecked regularly;knee joint function was evaluated according to Lysholm scores. Results：All the patients were followed from 12 months to 48 months with an average of 24 months. The wounds were healed by the first intention. The average healing time was 7.9 weeks（6-12 weeks）. Two cases showed stiff knee and flexion restriction three months later,all recovered to 5° to 120° flexion after physical therapy combined with CPM. Slight limitation of knee extension was found in 6 cases at 6 month after operation. For Lysholm scores of all patients,33 cases were excellent,6 cases were good,2 cases were fair and none was poor,the total excellent and good rate was 95.12%. The Lysholm knee scores were increased from preoperative 46.1±3.2 to the latest follow-up 95.5±1.2. A paired t-test was also conducted to find out the difference was statistically significant（t=58.7,P=0.000）. Conclusion：Taking into consideration the advantages of relative stability,no significant damage to the epiphysis,quick recovery of knee joint function,avoiding the second operation to remove the internal fixation,absorbable cartilage screws internal fixation is effective in treatment of tibial intercondylar eminence fracture in children.