关节镜下不可吸收缝线治疗胫骨髁间棘撕脱骨折的临床研究

Arthroscopic reduction and fixation in the treatment the avulsion fracture of the tibial eminence using non- absorbable sutures

目的探讨膝关节镜下采用不可吸收缝线治疗胫骨髁间棘撕脱骨折的临床疗效。方法采用关节镜下不可吸收缝线复位固定术治疗15例胫骨髁间棘撕脱骨折。患者均为单侧膝关节，左膝关节5例，右膝关节10例。依据Meyers—McKeever骨折分型：Ⅱ型1例，Ⅲ型9例，Ⅳ型5例。采用膝关节镜下前交叉韧带胫骨定位器引导，用不可吸收缝线于前交叉韧带胫骨附着处复位固定骨折块。结果15例病例均获随访，随访时间为2～27．5个月。所有患者切口均I期愈合，无感染、骨折移位、关节僵硬、下肢深静脉血栓等并发症发生。术后x线片示骨折均获解剖复位，骨性愈合时间为6～12周，平均7．8周。末次随访时，14例患膝活动度恢复正常，无伸直障碍、髁间窝撞击表现，膝关节伸屈活动度0°～125°，Lachman试验阴性；l例膝关节屈伸活动受限，活动度0°-90°，Lachman试验可疑阳性；所有患者前抽屉试验阴性。至末次随访，膝关节Lysholm评分为（94．33±5．46）分，与术前评分（47．67±16．69）分比较有明显改善（P〈0．01）；膝关节国际膝部文件委员会（IKDC）评分为（93．49±7．56）分，与术前评分（19．54±8．06）分比较有明显改善（P〈0．01）。结论膝关节镜下采用不可吸收缝线治疗胫骨髁间棘撕脱骨折疗效满意，且具有手术创伤小、术后康复快等优点。

Objective To investigate the clinical efficacy of arthroscopic reduction and fixation in the treatment the avulsion fracture of the tibial eminence using non - absorbable sutures. Methods A total of 15 patients with the avulsion fracture of the tibial eminence were subjected to non - absorbable suture fixation under arthroscopy. All the patients had unilateral knees, including.5 left knees and 10 right knees. Based on Meyers - McKeever classification, there were type II for 1 patient, type III for 9 patients and type IV for 5 patients. With the guide of tibial positioner of the anterior cruci- ate ligament, the avulsion fracture of the tibial eminence was reduced and fixed using non - absorbable sutures under knee arthroscopy. Results All the patients were followed up for 2 to 27.5 months. All incisions were healed within Phrase 1 without complications like infection, dislocation, joint stiffness and thrombosis in lower limb deep veins. The X -ray films showed fracture healing within 6 - 12 weeks （on the average of 7.8 weeks）. At the last follow - up, 14 patients showed normal activity of the knee joints without extension disorder, and impingement of intercondylar fossa, whose range of motion of the knee joint was 0° - 125°, in addition to negative results were found in the Lachman test. Only 1 patient reported limited range of motion of the knee joint （0° -90°）, in addition to suspicious positive results in the Lachman test. The results of anterior drawer tests were negative for all patients. At the last follow - up visit, the Lysholm score was 94.33±5.46, which was significant different from the preoperative one （47.67±16.69, P 〈 0.01 ）. The International Knee Documentation Committee Knee Evaluation Form （IKDC） score was 93.49 ± 7.56, which was significant different from the preoperative one （ 19.54± 8.06, P 〈 0.01 ）. Conclusions Arthroscopic reduction and fixation can produce good efficacy for treatment of the avulsion fractureof the tibial eminence using non - absorbable sutures, with less surgical incision and fast postoperative recovery.