关节镜下规避骺板法治疗儿童前交叉韧带胫骨止点撕脱性骨折

Arthroscopic treatment of flbial intercondylar eminence avulsion fracture in pediatric patients without epiphyseal interference

目的探讨关节镜下规避骺板法治疗儿童前交叉韧带（ACL）胫骨止点撕脱性骨折的临床疗效。方法回顾性分析2010年2月至2014年2月收治的18例儿童ACL胫骨止点撕脱性骨折患者资料，男12例，女6例；年龄为7～14岁，平均10．4岁。伴有半月板损伤4例，内侧副韧带损伤2例。受伤至手术时间为2-7d，平均4．5d。骨折按Meyers．McKeever分型：Ⅱ型13例，Ⅲ型5例。所有患者均采用关节镜下骨折块复位，并用Ultrabraid缝线打结，经膝横韧带下方将骨块固定于胫骨结节骨骺远方。术后随访根据前抽屉试验、轴移试验、Lachman试验及Lysholm膝关节功能评分评定患者功能恢复情况。结果18例患儿术后获10-24个月（平均15个月）随访。所有患儿骨折均获骨性愈合，愈合时间为3～6个月（平均4．5个月）。末次随访时患肢膝关节活动度恢复满意，无关节僵硬、松弛及功能障碍等表现；无骨骺损伤发生。末次随访时前抽屉试验、Lachman试验、轴移试验呈阴性，Lysholm膝关节功能评分由术前平均（45．6±7．4）分提高至（92．4±5．8）分，差异有统计学意义（t=-25．403，P〈0．001）。结论关节镜下规避骺板法治疗儿童ACL胫骨止点撕脱性骨折疗效满意，不会影响患儿的骨骼发育。

Objective To evaluate the clinical efficacy of arthroscopic treatment of tibial inter- condylar eminence avulsion fracture in pediatric patients without epiphyseal interference. Methods From February 2010 to February 201d, 18 children patients with avulsion fracture of tibial eminence were admitted. They were 12 boys and 6 girls, from 7 to 14 years of age （average, 10.4 years）. Four cases were complicated with meniscus injury and 2 with medial collateral ligament injury. The mean time from injury to surgery was 4, 5 days （range, from 2 to 7 days）. According to Meyers-McKeever classification, 13 children were type Ⅱ and 5 type Ⅲ. They were treated with Ultrabraid sutures arthroscopically. After reposition, the bone fragments were fixated to the distal epiphysis of tibial tubercle through the inferior of transverse ligament of knee to avoid epiphyseal injury. Anterior drawer test, Lanchman test, pivot shift test and Lysholm knee scoring were con- ducted at all clinical follow-up visits to assess functional recovery. Results All children were followed up from 10 to 24 months （average, 15 months）. The X-ray examination demonstrated bone union in all cases. At the end of follow-up, all children achieved satisfactory recovery of range of motion without complications like joint stiffness, joint relaxation, dysfunction or epiphyseal injury. The anterior drawer test, Lanchman test and pivot shift test were all negative at the last follow-up. The mean Lysholm knee scores improved significantly from preoperative 45.6 ± 7. 4 to 92.4 ± 5.8 at the final follow-up （ t = - 25. 403, P 〈 0. 01 ）. Conclu- sions Bone reposition under arthroscopy with suture fixation is reliable and minimally invasive in the treatment of avulsion fractures of tibia1 intercondylar eminence in pediatric patients.