膝关节前外侧韧带止点撕脱骨折的疗效观察

Observation of curative effect of avulsion fracture of anterolateral ligament of knee joint

目的探讨膝关节周围骨折合并前外侧韧带（anterolateral ligament，ALL）止点撕脱骨折的临床疗效。方法收集2014年6月至2015年11月我科采用星型钢板、空心钉、缝合锚钉固定方法治疗13例膝关节周围骨折合并ALL胫骨止点撕脱骨折，男9例，女4例，年龄28-51岁，平均39．5岁。其中股骨远端骨折合并ALL止点撕脱6例，胫骨平台骨折合并ALL止点撕脱4例，胫骨髁间嵴撕脱骨折合并ALL止点撕脱3例，术后膝关节卡盘式支具固定3个月。结果13例均获得随访，随访时间为4-20个月，平均13．5个月。本组手术时间90-210min，平均130min；13例术中全部明确找到并确认ALL。术后所有患者骨折愈合顺利，愈合时间10-12周，平均11．4周。7例采用星型钢板固定；5例采用空心螺钉固定；1例采用锚钉固定。术后随访拍摄膝关节正位、侧位X线片，并检查膝关节疼痛、肿胀情况及膝关节活动度，根据术前和术后IKDC评分、Lysholm评分及Tegner膝关节活动水平评价临床疗效。至末次随访，所有患者膝关节活动度正常，屈伸范围为0°-120°左右，术后膝关节Lysholm评分为86．5，IKDC主观评分为84．6，IKDC客观评分，9例评分为A，4例评分为B，Tegner膝关节活动水平术后6．7。切口愈合不良1例，经清洁换药32d后愈合。结论本研究证实了ALL的存在，对ALL止点撕脱骨折进行有效固定在13．5个月内临床疗效可靠。

Objective To explore the clinical effect of periarticular knee fractures combined with anterolateral ligament （ALL） avulsion fracture. Methods From June 2014 to November 2015, 13 patients with ALL avulsion fracture in periarticular knee fractures were fixed by the star plate, cannulated or screws suture anchor, including 9 male and 3 female with the mean age of 39.5 years （range from 28 to 51 years）. 6 patients were diagnosed distal femoral fracture, 4 tibial plateau fracture, and 3 tibial in- tercondylar eminence avulsion fracture which all combined with ALL avulsion fracture. Postoperatively, all patients were treated with the adjustable knee brace for 3 months. Results All patients were followed up for 4-20 months, the mean follow-up time was 13.5 months. The average surgical time was 130 rain （range from 90 to 210 min）. In all 13 patients, ALL was found and identi- fied. Bone union was obtained in all patients, and the bone union time was 11.4 weeks （10-12 weeks）. 7 cases were fixed with star plate, 5 eases were fixed with hollow screw, and 1 case was fixed with anchor. All follow-up patients underwent anteroposterior and lateral X-rays. Pain, swelling and functional recovery of the knee joint were observed. Patients were assessed postoperatively with International Knee Documentation Committee （IKDC） score, Lysholm score, and Tegner activity scale to evaluate the clinical ef- fect. At the last follow-up, all patients had full range of motion of the knee joint which from 0- to approximate 120-. The Lysholm, objective IKDC were 86.5 and 84.6 respectively. Among the 13 patients evaluated, 9 patients were graded A, and 4 patients were graded B by subjective IKDC. The Tegner activity scale at the last follow-up was 6.7. Incision of poor healing in 1 case, and got healed after 32 d cleaning dressing. Conclusion This study confirmed the presence of the ALL. The fixation of ALL avulsion fracture in periarticular knee fractures can be an effective procedure at a minimum follow-up of 13.5 months.