关节镜下复位逆行交叉克氏针固定治疗儿童胫骨髁间棘骨折

Arthroscopic reduction and fixation of anterior tibial spine fractures with K-wire in skeletally immature patients

目的探讨关节镜下复位逆行交叉克氏针固定治疗Ⅲ型儿童胫骨髁间棘骨折的疗效。方法回顾分析2014年1月至2015年12月北京积水潭医院采用关节镜下复位逆行交叉克氏针固定治疗手法复位失败的23例Ⅲ型新鲜胫骨髁间棘撕脱骨折患儿的病历资料。其中男10例,女13例;平均年龄10岁(7～14岁)。术后平均随访32个月(24～48个月)。以Lachnmn试验、轴移试验结果评价患膝关节稳定性,以Lysholm评分评价患膝关节功能。术后摄X线评价骨折愈合情况及是否存在骺早闭。结果 23例患儿骨折均获得良好复位,未见内固定断裂、骨块松动和感染等并发症。1例患膝关节屈曲活动受限,经二次松解手术后恢复正常。23例患儿末次随访时患膝关节Lachnmn试验和轴移试验结果均为阴性,患膝关节Lysholm功能评分为(96. 3±4. 8)分,术后3个月X线示骨折均获得骨性愈合。末次随访时X线检查未见骺早闭。结论关节镜下复位逆行交叉克氏针内固定治疗Ⅲ型儿童胫骨髁间棘骨折可有效重建患膝关节的稳定性,改善患膝关节功能,可避免二次内固定物取出手术,同时具有创伤小和费用低等优点。

Objective To describe and evaluate an ar/hroscopic technique using K-wire in displaced anterior tibial spine fractures in children. Methods Clinical data of 23 consecutive children with displaced anterior tibial spine fi＇actures undergone arthroscopic reduction and fixation of percutaneous retrograde K-wire in Beijing Jishuitan Hospital fi＇om January 2014 to December 2015 were retrospectively analyzed. There were 10 males and 13 females with mean age of 10（7-14） years. Mean follow-up duration was 32 （24-48）months. The stability of knee was assessed by Lachnmn test and pivot shift test. The knee function was assessed by Lysholm knee scoring scale. X-ray was used to determine the existence of early epiphyseal closure. Results All fractures were well reducted and no complications including rupture of internal fixator, fi＇acture loose and infection were observed. One patient had limited knee flextion and returned to normal after arthrolysis. All the 23 cases were excellent according to the results of Lachnmn test,pivot shift test and Lysholm knee scoring scale at the final follow-up. All fi＇actures achieved bone healing and no early epiphyseal closure occmTed. Conclusion Arthroscopic reduction and fixation with K-wire is an effective treatment for anterior tibial spine fractures in children and has advanced characters such as minimal invasion, simply operation, stable fixation and avoiding of reoperation for removal of implants.