不同微创关节镜下内固定式治疗Meyers-MckeeverⅢ-Ⅳ型胫骨髁间棘骨折的临床疗效与安全性比较

Clinical effects and safety comparison of different kinds of minimally invasive arthroscopic internal fixation in treatment of tibial eminence fracture with Meyers-Mckeever Ⅲ-Ⅳ type

目的：探讨微创关节镜下医用钢丝与Orthocord缝线内固定治疗Meyers-MckeeverⅢ-Ⅳ型胫骨髁间棘骨折临床疗效及其安全性差异.方法：研究对象选取胫骨髁间棘骨折患者共36例,采用随机抽签法分为对照组（医用钢丝关节镜下内固定）19例,观察组（Orthocord缝线关节镜下内固定）17例;比较2组患者围手术期临床指标、术后膝关节功能评分、屈伸活动度,Lachman试验阳性率及术后并发症发生率等.结果：对照组手术时间64.70±13.92分钟、止血带应用时间118.28±11.56分钟、骨性愈合时间7.35±1.09周、术后3个月膝关节屈伸活动度115.20° ±9.41°、术后6个月Lysholm评分90.96±3.29分、Lachman试验阳性率5.26％、术后并发症发生率10.52％;观察组手术时间40.84±10.78分钟、止血带应用时间115.74±11.13分钟、骨性愈合时间7.20±1.04周、术后3个月膝关节屈伸活动度140.72° ±14.39°、术后6个月Lysholm评分95.91±4.03分、Lachman试验阳性率5.88％、术后并发症发生率11.76％.手术时间,观察组明显短于对照组,组间比较差异有统计学意义（P〈0.05）;止血带应用时间,2组差异无统计学意义（P〉0.05）;骨性愈合时间,2组差异无统计学意义（P〉0.05）;膝关节功能评分,2组间差异有统计学意义（P〈0.05）;术后屈伸活动度,2组差异有统计学意义（P〈0.05）;Lachman试验阳性率,2组差异无统计学意义（P〉0.05）;术后并发症发生率,2组差异无统计学意义（P〉0.05）.结论：与常规医用钢丝比较,Orthocord缝线用于行微创关节镜下内固定治疗Meyers-MckeeverⅢ-Ⅳ型胫骨髁间棘骨折患者具有操作简便,术后膝关节功能恢复效果佳等优势,且未导致并发症发生风险上升.

Objectiv： To investigate the clinical efficacy and safety differences of Bone wires and Orthocord suture of minimally inva- sive arthroscopic internal fixation in the treatment of tibial eminence fracture with Meyers - Mckeever Ⅲ-Ⅳ type. Methods： 36 patients with tibial eminence fracture with Meyers - Mckeever Ⅲ-Ⅳ type were chosen and randomly divided into both group including A group （minimally invasive arthroscopic internal fixation by Bone wires,19 patients） and B group （minimally invasive arthroscopic internal fixa- tion by Orthocord suture, 17 patients） ; and the clinical index levels in perioperative period, the function scores and the flexion and exten- sion degree of knee joint after operation, the positive rate of Lachman test and the complications incidence after operation of both groups were compared. Results： In group A, the operation time, tourniquet application times, fracture healing time, flexion and extension de- gree of knee joint , function scores, positive rate of Lachman and positive rate of complications were（64.70 ± 13.92） min, （ 118.28 ± 11. 56）min,（7.35 ± 1.09）weeks,（115.20 ±9.41）°,（90.96 ±3.29）, 5.26%, 10.52% respectively. In group B, the date were（40.84 ± 10.78） rain, （115.74 ± 11.13）min, （7.20 ± 1.04）weeks, （ 140.72 ± 14.39）°, （95.91 ±4.03）, 5.88%, 11.76%. The operation time of B group were significantly shorter than A group （ P 〈 0.05 ）. There was no significant difference in the tourniquet application times and fracture healing time between 2 groups （ P 〉 0.05 ）. The function scores and the flexion and extension degree of knee joint after opera- tion of B group were significantly better than A group （ P 〈 0. 05 ）. There was no significant difference in the positive rate of Lachman and the complications incidence between 2 groups （ P 〉 0.05 ）. Conclusion： Compared with minimally invasive arthroscopic internal fixation by Bone wire, minimally invasive arthroscopic internal fixation by Orthocord suture in the treatment of tibial eminence fracture with Meyers - Mckeever Ⅲ-Ⅳ type could efficiently possess the advantage including simple operation and the better knee joint function recovery effect after oneration and not increase the complications risk.