Arthrex缝线联合免打结锚钉修复前交叉韧带胫骨止点撕脱骨折

Tibial avulsion fractures of anterior cruciate ligament repaired with Arthrex sutures passing through combining free knotting technique

背景:膝关节前交叉韧带胫骨止点撕脱骨折的治疗方法多样,各有优势。目的:探讨关节镜下应用两根Arthrex线双骨道联合pushlock免打结锚钉固定前交叉韧带胫骨止点撕脱骨折的手术方法及临床疗效。方法:纳入2014年12月至2015年11月在内蒙古医科大学第二附属医院住院治疗的23例前交叉韧带胫骨止点撕脱骨折患者,在关节镜下应用Arthrex线将骨折块十字交叉复位,在胫骨结节内侧拧入pushlock免打结锚钉以收紧Arthrex缝线,将骨折块牢固固定于胫骨髁间嵴附着点处。术后采用膝关节评分(Lysholm和Tegner评分)随访。应用前抽屉试验、Lachman试验评价膝关节稳定性,X射线片评价术后骨折端的复位及愈合。结果与结论:(1)23例患者随访时间为6个月-1年;(2)Lysholm关节评分术前为(47.31±6.16)分,术后为(94.69±1.28)分(P<0.05),Tegner评分由术前的(3.14±1.58)分提高到术后的(7.74±1.69)分(P<0.05);(3)查体:Lachman试验均为阴性,X射线片示骨折端愈合良好。未出现关节反复肿胀及交锁等机械症状,膝关节无屈伸活动受限,未出现感染、下肢深静脉血栓形成等其他并发症;(4)结果表明,关节镜下应用Arthrex线结合pushlock免打结锚钉固定前交叉韧带胫骨髁间嵴撕脱性骨折具有微创、操作简单、固定可靠、无金属内置物,效果满意等优点。

BACKGROUND： The treatment method of tibial avulsion fractures of anterior cruciate ligament is varied; each has its advantages.OBJECTIVE： To investigate the methods and clinical effects of the treatment of avulsion fractures of tibial insertion of anterior cruciate ligament by the means of making two decussate lines and four strands of non-absorbable Arthrex sutures passing through two bone tunnels combined with pushlock free knotting anchor under arthroscopy. METHODS： From December 2014 to November 2015, 23 cases of avulsion fractures of tibial insertion of anterior cruciate ligament were treated in the Second Hospital of Inner Mongolia Medical University. Under the arthroscopy, avulsed fracture was fixed in tibial intercondylar eminence by the means of making two decussate lines of Arthrex sutures passing through. At the same time, pushlock free knotting anchor beside tibial tubercle provided a tightening of tension for Arthrex sutures, which could strengthen the fixation of avulsion fracture blocks. Knee joint Lysholm and Tegner scores were followed up. Knee stability was evaluated by anterior drawer test and Lachman test. Postoperative reset and healing were evaluated with X-ray films. RESULTS AND CONCLUSION：（1） All 23 patients were followed up for 6 months to 1 year.（2） Lysholm scale of the knee function was（47.31±6.16） preoperatively and（94.69±1.28） postoperatively（P〈0.05）. Tegner score was（3.14±1.58） preoperatively and（7.74±1.69） postoperatively（P〈0.05）.（3） Lachman test of all cases was negative. X-ray films demonstrated that fracture healing was good. There was no repeated swelling or cross locking of the joint. The knee was not limited by flexion or extension. No infection or deep venous thrombosis of lower extremity occurred.（4） The method of Arthrex sutures passing through two bone tunnels combined with pushlock free knotting anchor under arthroscopy has the advantages of minimally invasive, simple operation, reliable fixation, no metal implants and satisfactory result to treat the tibial intercondylar eminence fracture of anterior cruciate ligament.