关节镜下Orthocord线“十字”固定前交叉韧带胫骨止点撕脱性骨折

Defective fracture of the tibia point of the "cross" fixation of the anterior cruciate ligament at the Orthocord suture under arthroscope

目的:探讨关节镜下Orthocord线“十字”固定前交叉韧带(ACL)胫骨止点撕脱性骨折的方法及临床疗效。方法:收治ACL胫骨止点撕脱性骨折患者28例,采取关节镜下Orthocord线“十字”固定术治疗,术后膝关节支具外固定,适当功能锻炼。术后即刻及3个月均行膝关节X线正侧位片,评估骨折复位及愈合情况;同时进行膝关节活动度及Lysholm评分、前抽屉试验及Lachman试验,评估患者术后膝关节活动功能及ACL恢复情况。结果:术后切口均Ⅰ期愈合,均获得13~27个月的随访。术后即刻X线片检查均示胫骨止点撕脱骨折复位良好,3个月后膝关节X线检查示,骨折复位及愈合状态均良好。前抽屉试验和Lachman试验均为阴性,Lysholm膝关节评分为(86.3±4.5)分,膝关节活动度均能达到0~130°,膝关节功能基本恢复至正常水平,未出现膝关节不稳及关节绞锁等并发症。结论:关节镜下Orthocord线“十字”固定ACL胫骨止点撕脱性骨折,能完成有效复位、牢固固定,创伤小、安全、高效。

Objective:To investigate the method and clinical effect of tear fracture of the anterior cruciate ligament(ACL)fixed by the"cross" of the Orthocord suture under arthroscope.Methods:28 patients with avachial fractures at the end of the ACL tibial bone were selected,the"cross"fixation of the Orthocord was performed under arthroscope.After the operation,the knee joint was external fixed and properly functional exercise was taken.Immediately and 3 months after the operation,the knee joint X-ray positive side film was performed to assess the fracture reduction and healing.At the same time,knee joint activity and Lysholm score,front drawer test and Lachman test were conducted to evaluate the knee joint activity function and ACL recovery.Results: The incisions were all healed in phase Ⅰ and all patients were followed up for 13~27 months.Immediately after the operation, X-ray examination showed that the tibial fracture at the end of the tibia was well restored.After 3 months,the knee X-ray examination showed that the fracture was well restored and healed.Both the front drawer test and the Lachman test were negative, and Lysholm knee joint score(86.3 ± 4.5)The knee joint activity can reach 0~130°,the knee joint function has basically returned to normal level,and no complications such as knee joint instability and joint strangulation occurred.Conclusion: Arthroscopic and Orthocord suture"cross"fixation ACL tibia fracture can complete effective reduction,solid fixation,with small trauma,safe and efficient.