关节镜下应用微型钢板治疗陈旧性前交叉韧带胫骨止点撕脱骨折

Application of Mini-plate Under Arthroscopy in the Treatment of Chronic Avulsion Fracture of Anterior Cruciate Ligament

目的探讨微型钢板在陈旧性前交叉韧带（anterior cruciate ligament,ACL）胫骨止点撕脱骨折中的应用价值。方法 2012年3月~2015年6月,在关节镜下对11例有明显移位的陈旧性ACL胫骨止点撕脱骨折复位,通过高强度不可吸收缝线（Ethibond）和微型钢板固定。结果随访5~26个月,（11.0±2.3）月。骨折均愈合,无骨折移位。术后3个月复查,无膝关节松弛或不稳定,屈、伸角度均与健侧相同（P〉0.05）。末次随访时国际膝关节评分委员会（International Knee Documentation Committee,IKDC）主观膝关节评分从67.6±5.3提高到95.1±3.3分（t=17.212,P=0.000）。结论关节镜下微型钢板配合缝线固定治疗陈旧性ACL止点撕脱骨折,复位和固定效果好,创伤小,可早期进行膝关节康复训练,能够早期恢复膝关节功能,是陈旧性ACL止点撕脱骨折一种有效的治疗方式,技术难度不大,费用相对低廉,值得推广。

Objective To evaluate the clinical outcome of mini-plate in the treatment of chronic avulsion fracture of anterior cruciate ligament. Methods A total of 11 cases of chronic avulsion fracture of anterior cruciate ligament with fragment displacement were fixed by unabsorbable Ethibond suture and mini-plates fixation through arthroscopy. Results All the patients acquired bony fusion without fragments displacement at the follow-up for 5- 26 months（ mean,11. 0 ± 2. 3 months）. At 3 months after operation,a normal range of motion was achieved in all the patients as compared to that of the unaffected knee（ P 〉 0. 05）. The International Knee Documentation Committee（ IKDC） subject scores were improved from 67. 6 ± 5. 3 to 95. 1 ± 3. 3（ t = 17. 212,P = 0. 000） at the last follow-up. Conclusions Chronic avulsion fracture of anterior cruciate ligament can be treated by mini-plate fixation with nonabsorbable Ethibond suture through arthroscopy. The advantages include excellent reduction,rigid fixation,less injury and early rehabilitation with good functional recovery. This kind of treatment is effective,simple and cost-effective,being worthy of wide application.