关节镜下可吸收线套扎固定治疗儿童陈旧性胫骨髁间棘骨折

Arthroscopic treatment for aged anterior tibial spine fracture with absorbable suture fixation in children

目的探讨关节镜下可吸收线套扎固定治疗儿童陈旧性胫骨髁间棘骨折的手术方法及疗效。为陈旧性胫骨髁间棘骨折的微创治疗提供一种有效、安全、可靠的方法。方法回顾性分析2014年1月至2017年1月获得1年以上随访的7例陈旧性胫骨髁间棘骨折患儿的临床资料。其中,男5例,女2例;外伤时间6个月至1年5个月,平均9个月。骨折类型按Meyers-McKeever分型:Ⅱ型3例,Ⅲ型4例。本组均采用关节镜下复位骨折块,PDS-Ⅱ可吸收缝合线套扎固定骨折块。术后4周拆除石膏开始进行功能锻炼,术后6周部分负重,术后12周可完全负重。患儿术前、术后末次随访时膝关节功能采用Lysholm膝关节评分。末次随访行双下肢全景站立位X线平片,记录双下肢长度及是否存在膝关节内外翻畸形。结果所有患儿均获12~18个月随访,平均15.3个月。骨折于3个月内一期愈合,平均术后3个月膝关节活动度恢复正常,无伸膝或屈膝受限,膝关节完全负重时无疼痛和活动受限、关节肿胀消失,前抽屉试验阴性,Lachman试验阴性。术后末次随访时Lysholm评分平均(93.8±3.1)分,与术前(42.7±2.7)分比较,差异有统计学意义(t=63.96,P<0.01)。结论关节镜下应用可吸收线套扎固定对于儿童陈旧性胫骨髁间棘骨折是一种安全有效的治疗方式,作为一种微创手术,疗效满意,值得进一步推广。

Objective To explore the efficacies of arthroscopic treatment for aged anterior tibial spine fracture with polydioxanone(PDS-II)suture fixation in children and to provide an effective,safe,reliable and mini-invasive treatment for old anterior tibial spine fracture.Methods Retrospective analysis was performed for 7 children with old tibial intercondylar spine fracture from January 2014 to January 2017.There were 5 boys and 2 girls.According to the Meyers&McKeever classification scheme,the fractures were divided into typeⅡ(n=3)and typeⅢ(n=4).All of them underwent arthroscopic reduction and PDS-Ⅱabsorbable suture for fixation.Gypsum was removed at 4 weeks postoperatively and functional exercises began.Weight was partially loaded at 6 weeks post-operation and completely loaded at 12 weeks postoperatively.Lysholm knee score was employed for evaluating knee functions before operation and at the last follow-up.At the last follow-up,standing plain films of both lower extremities were taken for recording the length of both lower extremities and the presence of varus deformity of knee joint.Results The average follow-up period was 15.3(12-18)months.All of them achieved primary healing within 3 months.The average motion range of knee joints normalized at 3 months postoperatively.There was no limitation of knee extension/flexion,pain or swelling of knee joint.Both anterior drawer and Lachman tests were negative.The average Lysholm score at the last follow-up was(93.8±3.1)as compared with the preoperative Lysholm score of(42.7±2.7).And the difference was statistically significant(t=63.96,P<0.01).Conclusions Arthroscopic fixation with absorbable suture is both safe and effective for old tibial intercondylar spine fracture in children.As a mini-invasive procedure,its curative effect is satisfactory and wider popularization is recommended.