关节镜下非经骨隧道缝线固定治疗儿童胫骨髁间嵴撕脱骨折

Arthroscopic non-transosseous suture fixation for tibial intercondylar avulsion fractures in children

目的探讨关节镜下非经骨隧道缝线固定治疗儿童胫骨髁间嵴撕脱骨折的临床疗效。方法回顾分析2015年1月~2018年12月我科收治的儿童胫骨髁间嵴撕脱骨折病例14例,根据Meyers-McKeever分型:Ⅱ型8例,Ⅲ型6例。采用关节镜下,两根5#爱惜邦不可吸收缝合线从撕脱骨折块前交叉韧带止点基底部处后方穿过并在前方交叉,腰穿针引导在内外侧半月板前角下方穿出,复位骨折块,收紧缝线,在胫骨结节内下方予锚钉固定。结果平均随访时间16个月,术前术后采用Lyshlom评分法进行功能评价,术前Lyshlom评分平均41.6(41.6±2.1)分,术后1年Lyshlom评分平均95.8(95.8±1.6)分,差异有统计学意义(P<0.05)。末次随访X线片显示骨折处均骨性愈合。膝关节屈伸活动功能良好。结论关节镜下非经骨隧道缝线固定治疗儿童胫骨髁间嵴撕脱骨折手术创伤小、术后恢复快,避免了损伤骨骺的风险,且无需再次手术取出内固定物,临床疗效满意。

Objective To explore the clinical effect of arthroscopic non-transosseous suture fixation for tibial intercondylar avulsion fractures in children.Methods A total of 14 cases of tibial intercondylar avulsion fractures children treated in our department from January 2015 to December 2018 were retrospectively analyzed.According to the Meyers-McKeever classification:8 cases were typeⅡand 6 cases were typeⅢ.Two 5#non-absorbable sutures were passed from the base of the anterior cruciate ligament stop of the avulsion fracture block and crossed in front under arthroscopy.The lumbar puncture was guided below the anterior angle of the inner and outer meniscus.The fracture block was reduced,the suture was tightened,and the anchor was fixed under the tibial tubercle.Results The average follow-up time was 16 months.Lyshlom score was used for functional evaluation before and after surgery.The average Lyshlom score was 41.6(41.6±2.1)points before surgery,which was lower than 95.8(95.8±1.6)points at 1 year after surgery,and the difference was statistically significant(P<0.05).The final follow-up X-ray showed all fracture sites were healed.The knee flexion and extension function was good.Conclusion Arthroscopic non-transosseous tunnel suture fixation in children with tibial intercondylar avulsion fractures has less trauma and rapid postoperative recovery,avoids the risk of osteophyseal injury,and does not require surgery to remove internal fixation.Its clinical effect is satisfactory.