关节镜下带线铆钉原位重建前交叉韧带胫骨髁间嵴粉碎性撕脱骨折

Arthroscopic anatomic reconstruction of tibial intercondylar eminence avulsion comminuted fracture by anchors

目的探讨关节镜下带线铆钉原位重建前交叉韧带（ACL）胫骨髁间嵴粉碎性撕脱骨折（Meyers Mckeever分型系统分为Ⅳ型）的临床疗效。方法对该科2009年10月-2015年4月收治15例ACL胫骨髁间嵴粉碎性撕脱骨折运用关节镜复位,带线铆钉原位重建,并通过胫骨结节骨隧道固定,手术后10例患者得到了随访,并进行回顾性分析。手术前常规行三维CT及MRI检查。15例患者均在受伤后21 d内进行了手术治疗,Meyers和Mckeever分型均为Ⅳ型,年龄为20~58岁,男10例,女5例,9例为慢速车祸外伤,4例为运动损伤,摔伤2例。手术前抽屉试验及Lachman征阳性,Lyscholm评分为（45.5±4.5）分,国际膝关节评分委员会（IKDC）2000评分为（52.6±3.2）分。结果对手术前、手术后第6和12个月行常规X线影像学检查,手术后6个月全部骨折愈合。前抽屉试验及Lachman试验阴性,IKDC 2000评分为（91.2±2.2）分,Lyscholm评分为（96.5±1.2）分,通过上述评分系统对手术前和手术后6个月的得分进行统计学分析,手术前与手术后6个月有着明显差别,两者差异具有统计学意义。结论关节镜下运用带线铆钉治疗ACL胫骨粉碎性撕脱骨折,具有复位精准,创伤小,可以最大限度避免膝关节副损伤,远期出现膝关节僵硬的几率变小,关节镜治疗ACL胫骨髁间嵴粉碎性撕脱骨折是一种可靠有效的治疗方式。

Objective To investigate the clinical effect of tibial intercondylar eminence avulsion comminuted fracture by arthroscopic treatment with anchors. Methods Retrospective analysis of 15 cases was used on arthroscopic treatment for tibial intercondylar eminence avulsion comminuted fracture. Three-dimensional computed tomography and magnetic resonance imaging were used to evaluate the injured knee According to Meyers and Mckeever classification. All 15 cases were rated to type Ⅳ. The double-Suture anchors were used to fix the comminuted fracture and bone tunnel was built and ACL was fixed by suture through bone tunnel at tubercle of tibia. Anterior drawer test and Lachman test of all patients were positive. Lyscholm and IKDC 2000 scores were（45.5 ± 4.5）,（52.6 ± 3.2）, respectively. The X-ray films was used to assess the reduction and the bone healing of tibial intercondylar eminence avulsion comminuted fracture at 1 day and 6 months post-operation respectively. Results All patients were followed no less 24 months The X-ray films showed good reduction and the healing of fracture 6 months after operation. The range of knee motion was 0~125°. The mean Lyscholm scores was significantly improved（96.5 ± 1.2） postoperatively. IKDC 2000 scores increased from preoperatively to（91.2 ± 2.2） postoperatively. Conclusion Arthroscopic treatment using anchors for tibial intercondylar eminence avulsion comminuted fracture was an effective method. Excellent reduction, anatomic reconstruction and bone healing with minimal invasion, simplicity and safety can be obtained.