关节镜下锚钉与Ethibond缝线固定治疗前交叉韧带胫骨止点撕脱性骨折的疗效比较

Comparative study on arthroscopic anchors fixation versus Ethibond suture fixation for anterior crueiate ligament tibial avulsion fractures

目的对比关节镜下锚钉缝线桥技术与Ethibond缝线骨隧道技术治疗前交叉韧带(ACL)胫骨止点撕脱性骨折的临床疗效。方法采用回顾性病例对照研究分析2012年6月— 2017年6月温州市中心医院收治的18例ACL胫骨止点撕脱性骨折患者临床资料,其中男14例,女4例;年龄12~57岁,平均31.4岁。Meyers-McKeever分型:Ⅱ型6例,Ⅲ型12例。7例行锚钉缝线桥固定(锚钉组),11例行Ethibond缝线骨隧道固定(Ethibond缝线组)。比较两组患者手术时间、术前及术后3,6,12个月膝关节活动度(ROM)、Lysholm评分及国际膝关节文献委员会(IKDC)评分。结果患者均获随访12~36个月,平均20.18个月。锚钉组手术时间[(87.1±8.6)min]长于Ethibond缝线组[(71.1±11.5)min](P<0.05)。术后3个月锚钉组与Ethibond缝线组ROM分别为(127.1±8.6)°、(124.1±7.4)°,差异无统计学意义(P>0.05);Lysholm评分为(91.9±3.0)分、(88.6±3.3)分;IKDC评分为( 85.6±4.1)分、( 79.9±4.9)分,差异有统计学意义(P<0.05)。两组患者术前与术后3,6,12个月ROM、Lysholm评分及IKDC评分比较差异均有统计学意义(P<0.05)。术后6,12个月锚钉组与Ethibond缝线组Lysholm评分、IKDC评分比较差异均无统计学意义(P>0.05)。结论关节镜下锚钉与Ethibond缝线均能实现对骨折的平面固定,在改善膝关节活动度、恢复膝关节功能方面远期疗效无明显差异,但锚钉组术后早期可获得更好的膝关节功能恢复。

Objective To compare the clinical results between arthroscopic anchor suture bridge and Ethibond suture bone tunnel for anterior cruciate ligament (ACL) tibial avulsion fractures.Methods A retrospective case control study was conducted to analyze the clinical data of 18 patients with ACL tibial avulsion fracture admitted to Wenzhou Central Hospital from June 2012 to June 2017.There were 14 males and four females,aged 12-57 years,with an average age of 31.4 years.According to the Meyers-McKeever classification,there were six patients with type Ⅱ and 12 patients with type Ⅲ.Seven patients underwent anchor suture bridge fixation (anchor group),and 11 patients underwent Ethibond suture bone tunnel fixation (Ethibond suture group).The operation time,range of motion (ROM) of knee joint,Lysholm knee score and International Knee Documentation Committee (IKDC)knee score of the two groups were compared before operation and 3,6 and 12 months after operation.Results All patients were followed up for 12-36 months,with an average of 20.18 months.The operation time of anchor group [(87.14 ±8.59)minutes] was longer than that of Ethibond suture group [(71.1 ± 11.5)minutes] (P < 0.05).The ROM of anchor group and Ethibond suture group was (127.1 ±8.6)° and (124.1 ±7.4)° respectively at 3 months after surgery,showing no statistical difference between the two groups (P > 0.05).But the functional knee scores (Lysholm score and the IKDC score) revealed better clinical results in anchor group [(9 1.9 ± 3.0) points,(85.6 ± 4.1) points respectively] than Ethibond suture group [(88.6 ± 3.3) points,(79.9 ± 4.9) points respectively] at 3 months after surgery (P < O.05).There were significant differences between before and after operation within two groups regarding the knee function scores including ROM,Lysholm knee score and IKDC score (P < 0.05).Three months after operation,there were significant differences between the two groups in terms of the Lysholm score and IKDC score (P < 0.05),but there were no statistical differences between two groups at 6 months and 12 months after surgery (P > 0.05).Conclusions Both arthroscopic anchor and Ethibond suture can achieve plane fixation of fracture,but there is no significant difference in the long-term effect of improving knee joint mobility and restoring knee joint function between the two approaches.However,the anchor group can achieve early recovery of knee joint function.