关节镜下带线锚钉固定治疗胫骨髁间嵴撕脱骨折的临床研究

Clinical research on suture anchor fixation for the treatment of avulsion fracture of tibial intercondylar eminence under arthroscopy

目的 :观察关节镜下带线锚钉固定治疗胫骨髁间嵴撕脱骨折的疗效。方法 :对2012年7月至2015年1月行关节镜下带线锚钉固定技术治疗的22例胫骨髁间嵴撕脱骨折患者的临床资料进行了回顾性研究,其中男12例,女10例;平均年龄22.8岁(18~33岁);右膝9例,左膝13例。从受伤到手术的平均间隔为6.8 d(3~11 d)。根据改良Meyers-Mc Keever分型:Ⅱ型13例,Ⅲ型7例,Ⅳ型2例。通过关节活动度、Lysholm评分、IKDC 2000主观膝关节评分、轴移试验、前抽屉试验对术后临床疗效进行评价。结果:所有患者术后切口Ⅰ期愈合,无相关并发症。22例均获得随访,平均随访时间32.8个月(18~42个月)。关节活动度由术前的(49.37±7.69)°提高到末次随访时的(126.38±5.58)°(P<0.01);Lysholm评分由术前的43.4±5.6提高到末次随访时的79.2±6.2(P<0.01);IKDC 2000评分由术前的52.6±6.2提高到末次随访时的81.4±5.7(P<0.01)。末次随访时对患者进行体格检查,1例术后18个月的患者轴移试验阳性,前交叉韧带松弛Ⅱ级;1例术后24个月的患者前抽屉征弱阳性。结论:关节镜下带线可吸收锚钉固定技术治疗胫骨髁间嵴撕脱骨折可对骨折块提供精确的复位和牢固固定,可应用于治疗包括粉碎性骨折的各种类型骨折,并且无须二次手术取出内置物。

Objective：To evaluate the early clinical effects of suture anchor fixation for the treatment of avulsion fracture of tibial intercondylar eminence under arthroscopy. Methods：From July 2012 to January 2015,22 patients with the avulsion fracture of tibial intercondylar eminence were treated with arthroscopic suture anchor fixation. There were 12 males and 10 females,with an average age of 22.8 years old（ranged,18 to 33 years old）. Nine patients had the fractures in the right knee and 13 patients had the fractures in the left knee. The mean duration from injury to surgery was 6.8 days（ranged,3 to 11 days）.According to the improved Meyers Mc Keever classification,13 cases were typeⅡ,7 cases were type Ⅲ,and 2 cases were typeⅣ. The clinical outcomes were evaluated by the range of motion,the Lysholm score,the IKDC 2000 subjective knee score,the axial shift test,and the anterior drawer test. Results：All the incisions healed by first intention,and no complications occurred.All the patients were followed up,and the mean duration was 32.8 months（ranged,18 to 42 months）. The knee range of motion was improved from preoperative（49.37±7.69） ° to（126.38±5.58） °at the latest follow up（P〈0.01）. Lysholm score was improved from preoperative 43.4±5.6 to 79.2±6.2 at the latest follow up（P〈0.01）. And the IKDC 2000 score was improved from preoperative 52.6±6.2 to 81.4±5.7 at the latest follow up（P〈0.01）. At the latest follow up,the patient underwent physical examination. One patient had a positive result of axial shift test at the 18 th month after operation with grade Ⅱ laxity of anterior cruciate ligament. One patient had a weakly positive result of anterior drawer test at the 24th month after operation. Conclusion：Absorbable suture anchor fixation for the treatment of avulsion fracture of tibial intercondylar eminence under arthroscopy can provide accurate reduction and stable fixation,which can be applied to treat all types of fractures including comminuted fracture,and it is not necessary to remove the implant in the second operation.