膝关节胫骨髁间区骨折的关节镜下诊治临床分析

The clinical analysis of arthroscopic diagnosis and repair of the intercondylar crest fracture of knee joint.

目的 为明确膝关节胫骨髁间区骨折的意义 ,与传统“髁间嵴骨折”概念相区别 ;探索其关节镜下表现、诊断和治疗效果。方法 对 4 6例胫骨髁间区骨折病人行关节镜检和镜下或结合切开骨折复位钢丝抽出或螺钉内固定术治疗 ,经膝关节检查功能评分和患者主观印象评价效果。结果 关节镜检发现髁间区骨折 4 6例全是十字韧带胫骨止端撕脱骨折 ,2例合并胫骨平台软骨及软骨下骨骨折累及髁间嵴 ;无 1例单纯髁间嵴骨折。术前 4 6例按功能障碍评分 15～ 33分 ,平均 2 5 .17分 ,术后 12周随访评分 1～ 9分 ,平均 4 .5 8分 ,治疗有效 :4 6例中优 5 0 %、良 8.70 %、中 32 .6 1%、差8.70 % ,积分平均改善率 85 .10 % ,主观评价满意度 91.6 7%。复查 X线片骨折复位及固定愈合满意。结论 关节镜检能明确诊断胫骨髁间区骨折并加以分类为 :1髁间嵴骨折 ;2十字韧带胫骨止端撕脱骨折 ;3十字韧带胫骨止端撕脱骨折伴髁间嵴骨折。尤其十字韧带胫骨止端撕脱骨折发生率极高 (近 10 0 % ) ,对认识十字韧带稳定性的功能丧失尤其重要。同时在关节镜下或结合切开行骨折复位、内固定的手术方法治疗以重建十字韧带稳定性。

Objective To define the meaning of avulsion fracture of the cruciate ligament,distinguish with'the intercondylar crest fracture' and explore the manifestations by arthroscope,diagnosis and therapeutic efficacy.Methods We have cured 46 cases with avulsion fracture of the cruciate ligament,all of them have had arthroscopy examination and been treated by steel wire avulsion method or screw internal fixation method for fracture replacement by arthroscope or patency.The effect is evaluated by knee joint functional examination and subjective judgement.Results By arthroscopy,we found that only 2 cases had additional tibial plateau cartilage and subchondral fracture whose regions included intercondylar crest.Before operation,the 46 cases scores of dysfunction were 15～33,averag 25.17,but 12 weeks follow up after operation showed that the scores were reduced to 1～9,averag 4.58,average score amelioration rate was 85.10%,and that satisfaction by subjective evaluation was 91.67%.The radiologic examination showed that farcture was replaced internal fixation was satisfactory,and fracture began healing.Conclusion The definitions of avulsion fracture of the cruciate ligament and'the intercondylar crest fracture'are different.Most people advocate that patients with avulsion fracture of the cruciate ligament should receive arthroscopy examination to find lesion and its type,then fracture is replaced and fixed,the cruciate ligaments stability is restored by arthoscope or patency.The operation method is that fracture is replaced by arthroscopy and patency,then steel wire avulsion method or screw(absorbable or unabsorbable)internal fixation method is chosen according to fracture masss size and number.After operation,the knee joint is fixed by gypsum for the fracture healing and the cruciate ligaments stability restoration.Above all,diagnosing and curing avulsion fracture of the cruciate ligament by arthroscopy is a good method worth recommending and applying.