关节镜下双带线锚钉内固定治疗Meyers-Mckeever Ⅲ、Ⅳ型胫骨髁间棘骨折中长期疗效观察

Medium and long term clinical curative effect of under the arthroscope to take line anchor nail internal fixation treatment on patients with Meyers-Mckeever Ⅲ,Ⅳ tibial condyle spine fractures

目的探讨关节镜下双带线锚钉内固定治疗Meyers-MckeeverⅢ、Ⅳ型胫骨髁间棘骨折的中长期临床疗效及安全性。方法选择2010年2月至2015年2月信阳市中医院收治的63例Meyers-MckeeverⅢ、Ⅳ型胫骨髁间棘骨折患者为研究对象。根据手术方式将所有患者分为钢丝组、空心螺钉组、双带线锚钉组,每组21例。钢丝组患者给予关节镜下医用钢丝内固定治疗,空心螺钉组患者给予关节镜下空心螺钉内固定治疗,双带线锚钉组患者给予关节镜下双带线锚钉内固定治疗。观察3组患者的手术时间、住院时间、手术次数及骨性愈合时间;比较3组患者治疗前及治疗后6、12、36个月的膝关节功能及术后并发症发生率。结果钢丝组、空心螺钉组及双带线锚钉患者的手术次数分别为2次、2次、1次。钢丝组、空心螺钉组患者手术时间、住院时间显著长于双带线锚钉组(P<0.05);钢丝组、空心螺钉组患者手术时间、住院时间比较差异无统计学意义(P>0.05)。3组患者骨性愈合时间两两比较差异无统计学意义(P>0.05)。3组患者治疗前、治疗后6个月Lysholm、Tegner、国际膝关节评分委员会(IKDC)评分比较差异无统计学意义(P>0.05)。3组患者治疗后6、12、36个月Lysholm、Tegner、IKDC评分均显著高于治疗前(P<0.05);3组患者治疗后12、36个月Lysholm、Tegner、IKDC评分均显著高于治疗后6个月(P<0.05);3组患者治疗后36个月Lysholm、Tegner、IKDC评分与治疗后12个月比较差异无统计学意义(P>0.05)。钢丝组、空心螺钉组患者治疗后12、36个月Lysholm、Tegner、IKDC评分显著低于双带线锚钉组(P<0.05)。钢丝组、空心螺钉组、双带线锚钉组患者术后并发症发生率分别为19.0%(4/21)、14.3%(3/21)、4.8%(1/21);3组患者术后并发症发生率两两比较差异无统计学意义(χ^2=0.000、0.281、0.911,P>0.05)。结论钢丝、空心螺钉及双带线锚钉内固定治疗Meyers-MckeeverⅢ、Ⅳ型胫骨髁间棘骨折在短期(6个月)内均能取得明显的临床效果,但双带线锚钉内固定术可缩短患者的手术时间和住院时间,中长期(12~36个月)疗效更好。

Objective To investigate medium and long term clinical curative effect and safty of under the arthroscope to take line anchor nail internal fixation treatment on patients with Meyers-Mckeever Ⅲ,Ⅳ tibial condyle spine fractures. Methods A total of 63 cases of Meyers-Mckeever Ⅲ,Ⅳ tibial condyle spine fractures in the Xinyang Hospital of Traditional Chinese Medicine from February 2010 to February 2015 were selected as the research objects.All patients were divided into steel wire group,hollow screw group and double-band wire anchor according to the surgical method,with 21 cases in each group.Patients in the wire group were treated with medical wire internal fixation under arthroscope,patients in the hollow screw group were treated with hollow screw internal fixation under arthroscope,and patients in the double wire anchor group were treated with double wire internal fixation under arthroscope.The operation time,hospitalization time,operation times and bone healing time of the three groups were observed.The knee function before and after treatment at 6,12 and 36 months and the incidence of postoperative complications in the three groups were compared. Results The operation frequency of the patients in the steel wire group,hollow screw group and double-band wire anchor group were two times,two times and one time respectively.The operation time and hospitalization time of patients in the steel wire group and hollow screw group were significantly longer than those in the double-band wire anchor group ( P <0.05).There was no significant difference in the operation time and hospital stay between the steel wire group and the hollow screw group ( P >0.05).There was no significant difference in the bone healing time between the steel wire group and hollow screw group and double-band wire anchor group ( P > 0.05).There was no significant difference in the Lysholm,Tegner and IKDC scores between the steel wire group and hollow screw group and double-band wire anchor group before and at 6 months after treatment ( P >0.05).The Lysholm,Tegner and IKDC scores of the three groups were significantly higher at 6,12 and 36 months after treatment than those before treatment ( P < 0.05).The Lysholm,Tegner and IKDC scores of the three groups were significantly higher at 12 and 36 months after treatment than those at 6 months after treatment ( P <0.05).There was no significant difference in the Lysholm,Tegner and IKDC scores in the three groups at 36 months after treatment compared with that at 12 months after treatment ( P >0.05).The Lysholm,Tegner and IKDC scores of patients in the steel wire group and hollow screw group were significantly lower than those in the double-band wire anchor group at 12 and 36 months after treatment ( P <0.05).The incidence of postoperative complications was 19.0%(4/21),14.3%(3/21),4.8%(1/21) in the steel wire group,hollow screw group and double-band wire anchor group,respectively;there was no significant difference in the incidence of postoperative complications in the three groups (χ^2=0.000,0.281,0.911;P > 0.05). Conclusion It can obtain short term (6 months) clinical effect treating by wire,hollow screw,double belt line anchor nail internal fixation for Meyers-Mckeever Ⅲ,Ⅳ tibial condyle between spine fractures,but the treatment of double belt line anchor nail internal fixation can shorten the operation time and hospitalization time of patients,medium and long term ( 12- 36 months) curative effect is better.