关节镜下缝线桥技术治疗儿童新鲜前交叉韧带胫骨止点骨折

Arthroscopic technique with suture bridge fixation for treating fresh avulsion fracture of adolescent tibial eminence of anterior cruciate ligament

目的评估在关节镜下缝线桥技术治疗儿童新鲜前交叉韧带胫骨止点撕脱骨折的临床疗效。方法回顾性分析2015年7月—2018年7月四川省骨科医院收治的儿童(14岁及以下骨骺未闭合者)新鲜前交叉韧带胫骨止点撕脱骨折50例,男性28例,女性22例;年龄9~14岁,平均10.6岁。运动伤20例,道路交通伤30例。所有患者采用关节镜下缝线桥技术治疗前交叉韧带胫骨止点撕脱骨折,术后通过X线片、MRI评估骨折愈合情况和下肢畸形情况,通过关节测量仪(KT-1000)、拉赫曼试验(Lachman test)评估关节松弛度,Lysholm和IKDC评分评价膝关节功能。结果50例患者均得到随访,随访时间12~48个月,平均31.1个月。通过术后膝关节X线片发现骨折均愈合,下肢全长X线片检查无一例发生短缩和成角畸形,Lysholm和IKDC评分由术前的(40.32±6.47)分、(48.54±9.76)分,改善为术后(92.58±4.46)分、(88.57±6.24)分。Lachman test弱阳性5例,KT-1000双侧差值为(1.94±0.81)mm,无一例超过3mm。结论关节镜下使用缝线桥技术治疗儿童新鲜前交叉韧带胫骨止点撕脱骨折临床效果满意。

Objective To evaluate the clinical efficacy and fluoroscopic outcomes of arthroscopic suturebridge technique for child patients with fresh tibial avulsion fractures of tibial eminence of the anterior cruciate ligament(ACL).Methods A retrospective analysis was conducted in 50 child patients diagnosed with fresh tibial avulsion fractures of the ACL.There were 28 males and 22 females,with an average age of 10.6 years(range,9 to 14 years).There were 20 cases of sports injuries and 30 cases of traffic injuries.Arthroscopic suture-bridge technique was used to treat tibial avulsion fractures of the ACL.Postoperative fluoroscopic images were used to evaluate fracture healing and lower limb deformity,KT-1000 arthrometer and Lachman test were used to assess knee laxity,and Lysholm score,IKDC score were used to evaluate knee joint function.Results All the 50 patients were followed up for12-48 months,with an average of 31.1 months.All the fractures obtained healing and no case of angular or short deformities was found.Lysholm score and IKDC score improved after surgery(Lysholm:40.32±6.47 vs.92.58±4.46;IKDC:48.54±9.76 vs.88.57±6.24).Only 5 cases were judged as weakly positive through Lachman test.The average difference value between the operated knee and normal knee through KT-1000 arthrometer was(1.94±0.81)mm,which was below 3 mm for all cases.Conclusion Arthroscopic suture-bridge technique for child patients with tibial avulsion fractures of the anterior cruciate ligament can achieve satisfying clinical and fluoroscopic results.