关节镜下三点缝合固定治疗前交叉韧带胫骨止点撕脱骨折的早期疗效

Early effectiveness of arthroscopic three-point suture technique in treatment of anterior cruciate ligament tibial eminence avulsion fracture

目的探讨关节镜下运用3点缝合技术固定治疗前交叉韧带(anterior cruciate ligament,ACL)胫骨止点撕脱骨折的早期疗效。方法 2016年1月-2017年12月,收治12例ACL胫骨止点撕脱骨折患者。男9例,女3例;年龄18~50岁,平均36.4岁。致伤原因:交通事故伤10例,运动损伤2例。左侧5例,右侧7例。陈旧性骨折1例,新鲜骨折11例。根据改良Meyers-McKeever分型标准:Ⅲ型7例,Ⅳ型5例。合并内侧副韧带损伤、内侧半月板损伤2例。国际膝关节文献委员会(IKDC)评分为(37.9±4.7)分,Lysholm评分为(46.0±3.7)分。关节镜下以Ethibon缝线采用3点缝合技术固定撕脱骨折。结果患者均顺利完成手术;手术时间45~70 min,平均61.3 min。手术切口均Ⅰ期愈合。术后住院时间4~9 d,平均5 d。患者均获随访,随访时间3~20个月,平均9.3个月。术后前抽屉试验、Lachman试验及轴移试验均为阴性。末次随访时,IKDC评分为(89.7±2.5)分,Lysholm评分为(90.2±1.9)分,均较术前明显提高(t=–30.94,P=0.00;t=–33.03,P=0.00)。末次随访时,X线片复查示骨折解剖复位9例、接近解剖复位3例,12例骨折均达骨性愈合。结论采用关节镜下3点缝合技术固定治疗ACL胫骨止点撕脱骨折,可有效恢复膝关节稳定性,早期疗效满意。

Objective To investigate the early effectiveness of three-point suture technique in treatment of anterior cruciate ligament(ACL) tibial eminence avulsion fracture by arthroscopy. Methods Between January 2016 and December 2017, 12 patients with ACL tibial eminence avulsion fractures underwent arthroscopic fixation of avulsion fractures with Ethibon suture using three-point suture technique. There were 9 males and 3 females, with an average of36.4 years(range, 18-50 years). The fracture caused by traffic accident in 10 cases and sports in 2 cases. Among them,1 patient was old fracture and 11 was fresh fracture. According to the modified Meyers-McKeever classification criteria,the fractures were rated as type Ⅲ in 7 cases and type Ⅳ in 5 cases. There were 2 cases of medial collateral ligament injury and medial meniscus injury. The preoperative International Knee Documentation Committee(IKDC) score was 37.9±4.7 and Lysholm score was 46.0±3.7. Results All operations completed smoothly. The operation time was 45-70 minutes(mean, 61.3 minutes). The incisions healed by first intention in all patients. The hospitalization stays ranged from 4 to 9 days(mean, 5 days). All patients were followed up 3-20 months(mean, 9.3 months). The anterior drawer test, Lachman test, and axis shift test in all patients were negative after operation. At last follow-up, the IKDC score was 89.7±2.5 and Lysholm score was 90.2±1.9, which were significantly higher than those before operation(t=–30.94, P=0.00;t=–33.03,P=0.00). At last follow-up, the X-ray films showed 9 cases of fracture anatomical reduction and 3 cases of almost anatomical reduction, and 12 cases of fracture healing. Conclusion For ACL tibial eminence avulsion fracture,arthroscopic three-point suture technique can effectively restore the stability of knee joint and obtain satisfactory early effectiveness.