关节镜下单个锚钉固定治疗急性期ACL止点撕脱骨折的效果探讨

Discussion on effect of ingle anchor fixation under arthroscopy in the treatment of acute ACL avulsion fracture

目的探讨关节镜下利用单个锚钉固定治疗急性期前交叉韧带(ACL)止点撕脱骨折的手术效果。方法 5例急性期ACL止点撕脱骨折(Meyers and MckeeverⅢ型)患者,采用硬腰联合麻醉或单侧肢体神经阻滞麻醉,膝关节镜前内、前外侧及髌韧带正中入路,刨刀清理骨折端,在胫骨撕脱面骨床的后缘处打入直径5.0 mm带双缝线锚钉1枚,将缝线环绕撕脱的ACL骨块建立胫骨隧道,将缝线引出胫骨表面后打结收紧固定。观察预后效果。结果 5例患者术后随访时间5~12个月,中位随访时间9.6个月。ACL撕脱骨折均达到接近解剖复位上的愈合,中位愈合时间3.8个月。Lysholm评分结果优4例,良1例。恢复过程中,均未发生骨折块移位、锚钉缝线松脱、关节感染、锚钉异物反应等。结论关节镜下利用单个带线锚钉固定治疗急性期ACL止点撕脱骨折具有操作相对简单、骨块固定牢靠、创伤小、经济可行的优点,术后配合膝关节支具保护及口服消炎止痛药,能获得骨折愈合,并恢复膝关节正常功能,值得临床推广。

Objective To discuss the surgical effect of single anchor fixation under arthroscopy in the treatment of acute anterior cruciate ligament(ACL) avulsion fracture. Methods There were 5 patients with acute avulsion ACL fracture(Meyers and McKeever type Ⅲ). All patients underwent spinal epidural anesthesia or unilateral limb nerve block anesthesia. The anterior internal and anterolateral approach of knee arthroscopy and the median approach of patellar ligament were performed, then planer to clean the fracture end. Inserted a 5.0 mm diameter double suture anchor at the posterior edge of the tibial avulsion facial bed, surround the avulsed ACL bone with sutures, and established a tibial tunnel. Tied the sutures out of the surface of the tibia to tie and tighten. The prognostic effect was observed. Results 5 patients were followed up for 5-12 months, with a median followup of 9.6 months. All ACL avulsion fractures were close to the healing on anatomical reduction, and the median healing time was 3.8 months. Lysolm score showed 4 excellent cases and 1 good case. During the recovery, there was no displacement of fracture block, loosening of bolt suture, joint infection, reaction of bolt foreign body, etc. Conclusion Arthroscopic fixation of acute ACL avulsion fracture with a single stature anchor has relatively simple operation, solid fixation of bone mass, small trauma, and economical feasibility. After the operation, with the protection of knee joint brace and oral anti-inflammatory painkiller, the fracture can be healed and the normal function of knee joint can be restored, which is worth clinical promotion.