空心钉结合张力带固定治疗后交叉韧带胫骨止点撕脱骨折

Treatment of Tibial Avulsion Fracture of the Posterior Cruciate Ligment with Cannulated Screw Combined with Tension Band Fixation

目的：探讨运用空心钉结合张力带固定治疗后交叉韧带胫骨止点撕脱骨折临床疗效。方法：2014年7月～2016年7月，25例膝关节后交叉韧带胫骨止点撕脱骨折患者，男20例，女5例；年龄19～57岁，平均33岁。膝关节X-ray、CT及MRI检查，均为后交叉韧带胫骨止点单一撕脱骨折。采用空心钉结合张力带固定治疗。术后第1周膝关节伸直位支具固定，期间行直腿抬高及股四头肌等长收缩锻炼，此后开始膝关节被动屈伸锻炼，2周后开始部分负重，4～6周完全负重。结果：共21例获得随访，时间10-18个月，平均14个月。术后10～16周骨折均愈合，平均12周；术后6～12个月骨折愈合后于原手术入路拆除内固定。于术后第6个月采用膝关节Lysholm评分标准评估膝关节功能：疼痛23．51±2．5分，肿胀9．86±0．05分，跛行4．83±0．14分，支撑4．85±0．08分，爬楼梯9．74±0．85分，不稳24．24±0．63分，下蹲4．58±0．32分，交锁14．75±0．93分，总分96．37±3．85分。结论：临床采用空心钉结合张力带固定治疗后交叉韧带胫骨止点撕脱骨折具有临床安全、内固定坚强可靠、促使早期功能锻炼，尽快恢复膝关节正常结构及功能，具有一定的临床价值。关键词张力带；空心钉；

Objectiv： To study the ,clinical effects of the treatment of tibial avulsion fracture of the posterior cruciate ligment with cannulated screw combined with tension band fixation . Methods： From January. 2011 and May 2013 , 25 patients of tibial avulsion fracture of the posterior eruciate ligment , （20 male and 5 female; Age 19 -57 , an average of 33 . All examined by x ray , CT and MRI for sure . Using cannulated screw combined with tension band fixation treatment . First week involved knees with a fixed , line during the straight leg raising and quadriceps exercise isometric contraction . Then exercise passive flexion and extension after 2 weeks beginning load , 4 to 6 weeks full load. Results： 21 patients were be followed up , for 10 18 months, an average of 14 months, bony union was obtained in all the patients in 10 16 weeks , an average of 12 weeks . Fracture healing alter 6 to 12 months to remove the internal fixations. In 6 months with the knee joint Lysholm criteria assessment for knee joint function ： pain （23.51±2.5 ） points, swelling （9.86 -0. 05）points, elaudication （4.83±0. 14） points, support （4. 85±0.08） points, climb the stairs （9.74±0.85） points, instability （24.24±0. 63 ） points, squat （4.58±0. 32） points, lock （ 14.75±0. 93 ） points, total score （ 96.37±3.85 ）. Conclusion： The treatment of tibial avulsion fracture of the posterior cruciate ligament using cannulated screw combined with tension band fixation is clinical safety , and strong internal fixation can early function exercise , as soon as possible to recover the normal structure and function of the knee joint , worth clinical promotion .