关节镜下高强线联合外排锚钉治疗前交叉韧带胫骨止点撕脱骨折

High strength wire under arthroscopy combined with outside anchor nail in treating Meyers McKeever Ⅱ,Ⅲ avulsion fracture of anterior cruciate ligament tibial check point

目的:探讨关节镜下高强线联合外排锚钉治疗Meyers-McKeever Ⅱ、Ⅲ型前交叉韧带胫骨止点撕脱骨折的临床疗效.方法:自2014年3月至2016年6月,采用关节镜下高强线联合外排锚钉治疗Meyers-McKeever Ⅱ、Ⅲ型前交叉韧带胫骨止点撕脱骨折患者21例,其中男13例,女8例;年龄18-48(26.40±5.42)岁.受伤部位:左膝9例,右膝12例.致伤原因:运动伤12例,坠落伤6,车祸伤3例.Meyers-McKeever分型:Ⅱ型16例,Ⅲ型5例.所有患者为新鲜闭合性单纯损伤,受伤至手术时间2~15 (6.20±2.63)d.观察并比较术前及术后6个月的Lysholm评分、IKDC评分及膝关节活动度变化以评价膝关节功能.结果:术后21例患者获得随访,时间12~24(14.30±3.01)个月.手术时间40~65(45.10±4.82) min,出血量5~15(10.05±2.75)ml.Lysholm评分由术前的(50.29±6.67)分提高至术后6个月的(92.48±2.18)分;IKDC评分由术前的(47.19±4.57)分提高至术后6个月的(90.71±2.22)分;膝关节活动度由术前的(83.05±5.33)°提高至术后6个月的(132.05±7.15)°.结论:关节镜下高强线联合外排锚钉治疗Meyers-McKeever Ⅱ、Ⅲ型ACL胫骨止点撕脱骨折创伤小,固定牢靠,临床效果满意.

Objective:To explore clinical effect of high strength wire under arthroscopy combined with outside anchor nail in treating Meyers McKeeverⅡ,Ⅲanterior cruciate ligament tibial check point.Methods:From March 2014 to June 2016,21 patients with Meyers McKeeverⅡ,Ⅲavulsion fracture of anterior cruciate ligament tibial check point were treated by high strength wire under arthroscopy combined outside anchor nail.There were 13 males and 8 females aged from 18 to 48 years old with an average of(26.40±5.42)years old.There were 9 cases injured on the left side,and 12 cases on the right side.The courses of disease included sports injuries of 12 cases,falling down injuries of 6 cases,and accident injuries of 3 cases.According to Meyers-McKeever classification,16 patients were typeⅡand 5 patients were typeⅢ.All fractures were fresh,closed and simple injury.The time from injury to operation ranged from 2 to 15 days with an average of(6.20±2.63)d.Lysholm score,IKDC score and the changes of knee mobility were observed and compared before operation and 6 months after operation.Results:Twenty-one patients were followed up for 12 to 24 months with an average of(14.30±3.01)months.Operation time ranged from 40 to 65 min with an average of(45.10±4.82)min,Blood loss ranged from 5 to 15 ml with an average of(10.05±2.75)ml.Lysholm score was improved from 50.29±6.67 before operation to 92.48±2.18 at 6 months after operation.IKDC scores was increased from 47.19±4.57 before operation to 90.71±2.22 at 6 months after operation.Knee joint activity was respectively(83.05±5.33)°and(132.05±7.15)°before operation and 6 months after operation.Conclusion:High strength wire under arthroscopy combined outside anchor nail in treating Meyers McKeeverⅡ,ⅢACL tibial check point has the advantages of less trauma,firm fixation,and satisfactory clinical effect.