关节镜下双头加压空心螺钉固定治疗青少年前交叉韧带胫骨止点撕脱骨折

Arthroscopic treatment of anterior cruciate ligament tibial eminence avulsion fracture with double heads compressive cannulated screw fixation in adolescents

目的探讨关节镜下使用双头加压空心螺钉内固定治疗青少年前交叉韧带(anterior cruciate ligament,ACL)胫骨止点撕脱骨折的临床疗效。方法 2014年6月—2017年6月,采用关节镜下双头加压空心螺钉内固定治疗青少年ACL胫骨止点撕脱骨折患者24例。其中男15例,女9例;年龄5～18岁,平均12.3岁。体质量指数19.3～26.4 kg/m2,平均23.3 kg/m2。致伤原因:交通事故伤10例,运动伤8例,摔伤6例。骨折按Meyers-Mc Keever分型,Ⅱ型19例,Ⅲa型5例。术前前抽屉试验及轴移试验均为阳性。受伤至手术时间3～14 d,平均6.2 d。术后随访复查X线片了解骨折愈合情况,采用Lysholm评分、国际膝关节文献委员会(IKDC)评分及Tegner评分评价膝关节功能。结果患者术后切口均Ⅰ期愈合。24例患者均获随访,随访时间6～32个月,平均16.4个月。术后6周,3例患者出现膝关节屈曲功能锻炼困难,行手法松解,术后6个月屈膝范围达正常。末次随访时,X线片复查示骨折均骨性愈合,未见骺板发育异常;双下肢等长,无明显膝关节畸形;Lysholm评分由术前(44.3±5.4)分提高为(93.1±4.3)分,IKDC评分由(43.7±4.4)分提高为(94.6±3.3)分,Tegner评分由术前(3.0±1.3)分提高至(8.1±1.2)分,差异均有统计学意义(t=25.152,P=0.000;t=28.634,P=0.000;t=13.226,P=0.000)。结论关节镜下双头加压空心螺钉内固定治疗青少年ACL胫骨止点撕脱骨折(Meyers-Mc KeeverⅡ、Ⅲ型)具有创伤小、手术操作简便、固定可靠的优点,对患者骺板无明显影响,关节功能恢复好,临床疗效满意。

Objective To discuss the effectiveness of arthroscopic treatment of anterior cruciate ligament（ACL） tibial eminence avulsion fracture in adolescents by using double heads compressive cannulated screw fixation.Methods Twenty-four patients with ACL tibial eminence avulsion fractures were treated by arthroscopic reduction and internal fixation with double heads compressive cannulated screw fixation between June 2014 and June 2017. There were15 males and 9 females with an average age of 12.3 years（range, 5-18 years）. The body mass index was 19.3-26.4 kg/m2（mean, 23.3 kg/m2）. The injury causes included traffic accident injury in 10 cases, sports injury in 8 cases, and falling injury in 6 cases. According to the Meyers-Mc Keever classification, there were 19 cases of type Ⅱ and 5 cases of type Ⅲa.All patients＇ drawer test and pivot shift test were positive. The interval between injury and operation was 3-14 days（mean, 6.2 days）. During the follow-up period, the fracture healing condition of patients were determined by X-ray examination; Lysholm score, International Knee literature Committee（IKDC） score, and Tegner score were used to evaluate the knee function. Results Primary healing of incision was obtained in all patients after operation. All the24 patients were followed up 6-32 months（mean, 16.4 months）. At 6 weeks after operation, 3 patients had difficulty in knee flexion. After the release of the knee joint by manipulation, the knee joint function recovered normally at 6 monthsafter operation. At last follow-up, the X-ray films showed that all the fractures healed and no epiphyseal dysplasia, knee joint deformity, or leg length discrepancy occurred. The Lysholm score, IKDC score, and Tegner score were improved from preoperative 44.3±5.4, 43.7±4.4, and 3.0±1.3 to postoperative 93.1±4.3, 94.6±3.3, and 8.1±1.2, the differences were all significant（t=25.152, P=0.000; t=28.634, P=0.000; t=13.226, P=0.000）. Conclusion The arthroscopic reduction and internal fixation with double heads compressive cannulated screw in treatment of ACL tibial avulsion fracture（MeyersMc Keever type Ⅱ and Ⅲ） in adolescents has so many advantages, such as minimal trauma, simple operation, firm fixation, little effect on the epiphyseal plate, and has a good joint function recovery.