关节镜下带线锚钉治疗儿童胫骨髁间嵴撕脱性骨折的疗效

Arthroscopic treatment for avulsed fracture of tibial intercondylar eminence with suturing anchors in _pediatric patien~

目的探讨关节镜下带线锚钉固定治疗儿童胫骨髁间嵴撕脱骨折的手术疗效。方法回顾性分析2012年1月至2014年9月我科收治的胫骨髁间嵴撕脱骨折患儿23例，其中男16例，女7例，年龄8～17岁（平均14.5岁），受伤至手术时间为1～12 d（平均6.0 d）。所有患儿均在关节镜下复位骨折块后使用带线锚钉进行固定。术后随访复查X线片、MR、Lysholm评分、国际膝关节文献委员会（IKDC）评分。结果术后随访25～33个月（平均29.1个月）。术后，MRI示锚钉固定位置稳定，未及骨骺线。X线示所有患儿骨折均获骨性愈合，愈合时间为6～12周（平均8.7周）。末次随访时，19例患儿X线片示骨骺线可见，未见骨骺损伤。4例患儿X线片示骨骺线模糊，提示骨骺已闭，但是未见骨端形态明显异常。所有患儿膝关节活动度恢复满意，未见内外翻畸形，未见双下肢不等长畸形，前抽屉试验、Lachman试验及轴移试验均呈阴性。术前Lysholm评分为（53.5±11.4）分，末次随访时为（92.4±6.7）分（P〈0.05）；术前IKDC评分为（54.1±8.8）分，末次随访时为（93.1±6.4）分（P〈0.05）。结论关节镜下使用带线锚钉固定儿童胫骨髁间嵴撕脱骨折，其操作简单，创伤小，固定可靠，且不易损伤骨骺，是治疗该类型骨折的较为理想的方法。

ObjectiveTo evaluate the clinical efficacies of arthroscopy-assisted fixation of tibial intercondylar eminence avulsion fracture with suturing anchors in pediatric patients.MethodsA total of 23 hospitalized patients with avulsed fracture of tibial intercondylar eminence between January 2012 and September 2014 were collected retrospectively.There were 16 males and 7 females with a mean age of 14.5（8-17） years. Their mean time from injury to surgery was 6.0 （1-12） days.All patients underwent arthroscopic operations via suturing anchors. Follow-up examinations included radiograph, magnetic resonance imaging （MRI）, Lysholm score and International Knee Documentation Committee （IKDC） rating scale. ResultsFollow-ups were conducted for a mean period of 29.1（25-33） months. Postoperative MRI showed the position of suturing anchors was satisfactory and suturing anchors did not reach the growth plate. Radiographic examinations demonstrated bone union in all cases and the average healing time was 8.7（6-12） weeks. At the end of follow-ups, radiographic examination demonstrated epiphyseal line was visible without physeal injuries in 19 cases. And radiograph of 4 cases showed a fuzzy epiphyseal line. It hinted at closure of epiphysis, but there was no obviously abnormal bone morphology. Satisfactory range-of-motion recovery was achieved without varus, valgus knee deformity or leg length discrepancy. Anterior drawer, Lachman and pivot shift tests were all negative. Mean Lysholm scores improved from preoperative 53.5±11.4 to 92.4±6.7 at the final follow-up （P〈0.05）. The mean International Knee Documentation Committee （IKDC） scores improved preoperatively from 54.1±8.8 to 93.1±6.4 at the final follow-up （P〈0.05）. Conclusions Arthroscopy-assisted fixation with suturing anchors is efficacious for avulsed fracture of tibial intercondylar eminence. It offers the advantages of operative simplicity, minimal trauma, reliable fixation and damaging no growth plate.