关节镜下双“8”字Orthocord缝线固定ACL胫骨止点撕脱骨折

Double 8-Shaped Orthocord Suture Fixation for Avulsion Fracture of Anterior Cruciate Ligament Attibial Insertion Under Arthroscopy

目的探讨关节镜下应用高强度缝线双“8”字固定治疗前交叉韧带止点撕脱骨折的手术方法及临床疗效。方法自2012年5月至2018年7月,对应用关节镜下高强度缝线双“8”字固定治疗前交叉韧带胫骨止点撕脱骨折的23例患者资料进行回顾性分析,其中男16例,女7例;年龄16~48岁,平均(28.5±3.0)岁。采用Lysholm、国际膝关节文献委员会(international knee documentation committee,IKDC)评分系统评价膝关节的功能情况。通过Lachman试验评价膝关节稳定性。结果23例患者均获随访,随访时间7~16个月,平均(11.0±2.8)个月。术后3个月全部患者均获骨性愈合。术前Lysholm评分(51.4±6.7)分,术后6个月提高至(91.4±4.0)分(P<0.05)。术前IKDC评分(51.3±6.8)分,术后6个月提高至(93.3±2.4)分(P<0.05)。Lachman试验:术前阳性率为100%,术后阳性率为0(P<0.05)。无关节感染、骨折块移位、缝线断裂等并发症发生。结论关节镜下应用高强度缝线行双“8”字固定治疗前交叉韧带胫骨止点撕脱骨折,手术疗效满意,具有复位良好、固定牢靠、可早期行膝关节功能锻炼等优点,是治疗前交叉韧带止点撕脱骨折的一种可靠的方法。

Objective To explore the surgical method and clinical effect of high strength suture double 8-shaped fixation for avulsion fracture of anterior cruciate ligament under arthroscope.Methods From May 2012 to July 2018,a retrospective analysis was conducted on the data of 23 patients with avulsion fracture of anterior cruciate ligament at the tibial insertion treated with highstrengthdouble 8-shapedsutureunder arthroscopy,including 16 males and 7 females aged from 16 to 48 years,with an average of(28.5±3.0)years.Lysholm and IKDC scoring system were used to evaluate the function of knee joint.Knee stability was evaluated by Lachman test.Results The patients were followed up for 7 to 16 months,with an average of(11.0±2.8)months.3 months after the operation,all the patients got bone healing.Lysholm score was(51.4±6.7)before surgery,and increased to(91.4±4.0)6 months after surgery(paired t test,t=26.0,P<0.05).The preoperative IKDC score(51.3±6.8)was increased to(93.3±2.4)6 months after the operation(paired t test,t=30.1,P<0.05).Lachman testshowed that the preoperative positive rate was 100%and the positive rate was 0 after surgery(P<0.05).No joint infection,fracture block displacement,suture fracture and other complications occurred.Conclusion Under arthroscopy,the avulsion fracture of the anterior cruciate ligament at the tibial insertion point were fixedwith double 8-shapted highstrength suture.The surgical effect is satisfactory,with good reduction and firm fixation.The knee joint can be exercised in the early stage,which is a reliable method for avulsion fracture of the anterior cruciate ligament at the insertion point.