关节镜下手术治疗Meyers-Mckeever-Zaricnyj Ⅳ型胫骨髁间嵴骨折患者7例报告及文献复习

Surgery treatment of Meyers-Mckeever-Zaricnyj type Ⅳ tibial eminence fracture patients under arthroscope:A report of 7 cases and literature review

目的:观察Endobutton结合缝线治疗Meyers-Mckeever-ZaricnyjⅣ型胫骨髁间嵴骨折的疗效,探讨Ⅳ型骨折的特点和治疗方法。方法:收集7例Meyers-Mckeever-ZaricnyjⅣ型胫骨髁间嵴骨折患者的临床资料,结合相关文献,分析患者手术治疗方法、操作要点及注意事项。结果:经关节镜探查清理后,梳理出3块主骨折块:前交叉韧带连接骨块(ACLCF)、外侧半月板前角连接骨块(ALMCF)和后内侧软骨连续骨块(PMCCF),采用由后到前、由深到浅的顺序进行预复位,首先固定PMCCF,再固定ALMCF和ACLCF,避免骨隧道外口处骨桥切割继发移位。7例患者随访时间为6~12个月,平均随访时间为7个月。前抽屉试验(-),Lachman试验(-);患者术前平均Lysholm评分小于末次随访评分(P<0.05)。患者膝关节稳定性好,无运动障碍,无感染。结论:Meyers-Mckeever-ZaricnyjⅣ型髁间嵴骨折术中复位顺序至关重要,Endobutton结合缝线能够实现骨折块的完美固定。

Objective:To observe the efficacy of Endobutton combined with the suture in the treatment of Meyers-Mckeever-Zaricnyj typeⅣtibial eminence fracture,and to explore the characteristics and treatment methods of Meyers-Mckeever-Zaricnyj typeⅣfracture.Methods:The clinical data of seven patients with Meyers-MckeeverZaricnyj type Ⅳ tibial eminence fracture were collected;the literature review was performed,and the surgical treatment methods,key points of operation and precautions of the patients were analyzed.Results:After arthroscopic debridement,3 kinds of main fractures were found:anterior cruciate ligament connected fragment(ACLCF),anterior horn of lateral meniscus connected fragment(ALMCF),and posterior-medial cartilage connected fragment(PMCCF).The PMCCF was first fixed after pre-reduction from back to front and from deep to shallow orders,then the ALMCF and ACLCF were fixed,avoiding the secondary displacement and bone cutting.The follow-up periods of 7 patients were 6-12 months,with an average followed-up period of 7 months.The front drawer test(-),Lachman test(-);the average Lysholm score of patients before operation was less than that in the last follow-up period(P<0.05).The knee joint stability of patients was good,and the knee joint had no movement disorder and infection.Conclusion:The intra-operative reduction order is crucial during the operation of Meyers-Mckeever-Zaricnyj typeⅣ tibial eminence fracture.Perfect fixation can be achieved by using Endobutton combined with suture.