关节镜下单胫骨隧道技术治疗前交叉韧带胫骨止点撕脱性骨折的近期疗效

Arthroscopic single tibial tunnel technique for tibial avulsion fracture of the anterior cruciate ligament:short-term outcomes

目的探讨关节镜下单胫骨隧道联合免打结锚钉固定治疗前交叉韧带(ACL)胫骨止点撕脱性骨折的近期疗效。方法纳入12例ACL胫骨止点撕脱性骨折患者,其中男7例,女5例,年龄27~71岁,平均(44.8±14.3)岁。8例为摔伤、2例为交通事故、2例为运动伤。依据Meyers-McKeever分型:Ⅱ型9例、Ⅲ型3例,其中合并半月板损伤2例、合并膝关节外侧副韧带损伤2例。所有患者均采用关节镜手术治疗,镜下通过2根Orthocord缝线复位骨折块,在胫骨结节内侧通过单胫骨隧道拧入可吸收免打结锚钉收紧缝线,固定ACL胫骨止点撕脱骨折。术后应用X线及CT评价骨折复位及愈合情况;应用前抽屉试验及Lachman试验评价膝关节稳定性;应用国际膝关节文献委员会(IKDC)评分及Lysholm评分评价膝关节功能。结果所有患者顺利完成手术,术后无伤口感染、关节腔感染、下肢深静脉血栓等并发症。12例患者均获得有效随访,随访时间5~18个月,平均(12.6±4.9)个月。术后及随访期间患者前抽屉试验及Lachman试验均为阴性,膝关节无伸屈功能受限。末次随访时,所有患者均获得骨性愈合,IKDC评分由术前的(39.17±3.56)分改善为(90.33±1.61)分,Lysholm关节评分由术前的(42.92±1.96)分改善为(93.08±1.88)分(均P<0.01)。结论关节镜下单胫骨隧道应用Orthocord缝线结合可吸收免打结锚钉固定ACL胫骨止点撕脱骨折具有创伤小、固定牢靠、无金属内置物等优点,早期疗效满意。

Objective To investigate the short-term clinical outcomes of arthroscopic single-tibial tunnel knotless suture anchor fixation in the treatment of tibial avulsion fracture of the anterior cruciate ligament(ACL).Methods Twelve patients with ACL tibial avulsion fractures were included in the study,including 7 males and 5 females,with an average of(44.8±14.3)years(range 27-71 years).There were 8 cases caused by bruise,2 cases of traffic accident and 2 cases of sports injuries.According to Meyers-McKeever classification criteria:9 cases were typeⅡand 3 cases of typeⅢ.There were 2 cases of meniscus injury and 2 cases of lateral collateral ligament injury.Under the arthroscopy,two Orthocord sutures were used to reduce the fracture,knotless suture anchor was screwed into the tibial tubercle through the single tibial tunnel to tighten the Orthocord sutures to reduce the ACL tibial fracture.X-rays and CT scan were used to evaluate fracture reduction and healing.Drawer test and Lachman test were used to evaluate knee joint stability.International Knee Documentation Committee(IKDC)score and Lysholm score were used to evaluate knee function after operation.Results All patients successfully completed the operation without complications such as wound infection,joint infection or deep vein thrombosis.All patients were followed up 5-18 months(mean,12.6 months±4.9 months).The anterior drawer test and Lachman test were negative for all patients after operation.At last follow-up,the X-ray film and CT scan showed that all cases achieved bone healing.The IKDC score improved from(39.17±3.56)points before surgery to(90.33±1.61)points after operation(P<0.01).The Lysholm joint scores improved from(42.92±1.96)before surgery to(93.08±1.88)points after operation(P<0.01).Conclusion The method of Orthocord sutures passing through single tibial tunnel combined with knotless suture anchor under arthroscopy have the advantages of minimally invasive,reliable fixation and no metal implants.