关节镜下钢丝“8字”固定治疗前交叉韧带胫骨止点撕脱性骨折

Arthroscopic ‘8' shaped wire fixation for treating avulsion fractures of tibial insertion of anterior cruciate ligament

目的 探讨关节镜下钢丝“8字”固定治疗前交叉韧带（ACL）胫骨止点撕脱性骨折的手术方法及临床疗效。方法 选取2011年7月至2014年7月行关节镜下钢丝“8字”固定治疗的ACL胫骨止点撕脱性骨折患者33例,按Meyers-Mckeever分型标准：Ⅱ型18例,Ⅲ型10例,Ⅳ型5例。Lachman试验及前抽屉试验均为阳性。关节镜辅助下骨折复位后采用钢丝在ACL撕脱骨折块的前上方交叉后呈“8字”形固定。通过体格检查、影像学检查、膝关节Lysholm评分及国际膝关节文献委员会（IKDC）2000评分评估疗效。患者均获随访10-28个月,平均（16.0±5.5）个月。结果 术后12周患膝关节Lachman试验及前抽屉试验均为阴性。无膝关节不稳症状。术后6个月骨折均愈合,末次随访时除3例遗留轻度膝关节伸直受限外,其余患者伸膝范围均正常;屈膝范围均大于130°。Lysholm评分[（94.2±3.9）分]及IKDC2000评分[（93.5±3.5）分]均高于术前[分别为（48.3±4.5）、（43.7±3.0）分],差异均有统计学意义（P〈0.05）。结论 关节镜下钢丝“8字”固定治疗ACL胫骨止点撕脱性骨折具有手术创伤小、ACL胫骨止点解剖复位、固定牢固等优点,术后患者膝关节功能恢复良好。

Objective To explore the surgical method and clinical effect of arthroscopic ‘8 ’ shaped wire fixation for treating avulsion fractures of tibial insertion of anterior cruciate ligament （ACL）. Methods Thirty-three patients with ACL tibial insertion avulsion fractures treated by arthroscopic ‘8’ shaped wire fixation from July 2011 to July 2014 were selected,including 18 cases of typeⅡ,10 cases of typeⅢand 5 cases of typeⅣaccording to Meyers-McKeever classification criteria. The results of Lachman test and anterior drawer test all were positive. After arthroscopic reduction of fracture ,the tibial insertion avulsion frac-tures were fixed with ‘8’ shaped wire. The curative effects were evaluated by the physical examination,imaging examination, knee joint Lysholm score and IKDC200 score. The patients were followed up for 10-28 months,averaged（16.0±5.5） months. Re-sults The knee joint Lachman test and anterior drawer test at postoperative 12 weeks were negative. No symptoms of knee joint instability occurred. The fracture was healed at postoperative 6 months. Except 3 cases left slight knee extension limitation at last follow-up,the knee extension range of motion（ROM） in the other cases was normal;the knee flexion ROM was more than 130° in all patients. The Lysholm score and IKDC2000 score were （94.2±3.9） points and （93.5±3.5） points at last follow-up,which were significantly higher than（48.3±4.5）points and（43.7±3.0）points before operation,the differences were statistically significant（P〈0.05）. Conclusion Arthroscopic ‘8’ shaped wire fixation of avulsion fractures of tibial insertion of anterior cruciate ligament has the advantages of minimal trauma,anatomic reduction,reliable fixation and good recovery of the knee joint function.