关节镜下带线锚钉四点固定治疗胫骨髁间棘撕脱骨折的疗效分析

Arthroscopic treatment of tibial eminence avulsion fracture by four-point fixation with suture anchors

目的探讨关节镜下带线锚钉四点固定治疗胫骨髁间棘撕脱骨折的临床疗效。方法回顾性分析2015年1月至2018年12月期间青岛大学附属医院运动医学科由同一组医生在关节镜下使用带线锚钉四点固定治疗的58例胫骨髁间棘撕脱骨折患者资料。男33例,女25例;平均年龄为18.4岁(14~32岁);骨折根据改良Meyers-McKeever分型:Ⅱ型15例,Ⅲ型19例,Ⅳ型24例。记录并比较患者术前与术后1年的膝关节Lysholm评分、国际膝关节文献委员会(IKDC)评分、胫骨髁间棘高度,记录患者末次随访时关节活动度、Lachman试验及轴移试验结果。结果58例患者术后获平均20.7个月(12~33个月)随访。本组患者均在术后12周内达到骨性愈合。所有患者术后1年膝关节Lysholm评分[(85.2±4.9)分]、IKDC评分[(86.2±4.3)分]显著高于术前[(43.2±5.2)、(51.2±4.9)分],胫骨髁间棘高度[(9.1±1.2)mm]显著低于术前[(12.6±1.2)mm],差异均有统计学意义(P<0.05)。术后1年胫骨髁间棘高度与膝关节Lysholm评分及IKDC评分之间的相关系数分别为-0.16、-0.17(P>0.05)。末次随访时患者关节活动度为132°±5°,3例患者轴移试验阳性(Ⅱ级),2例患者Lachman试验阳性(Ⅰ级)。结论关节镜下带线锚钉四点固定治疗胫骨髁间棘撕脱骨折疗效满意,具有微创、解剖复位、固定可靠等优点,且对骺板无明显影响。

Objective To explore the clinical effectiveness of arthroscopic treatment of tibial eminence avulsion fracture by four-point fixation with suture anchors.Methods A retrospective analysis was performed of the 58 patients with tibial eminence avulsion fracture who had been treated by the same group of surgeons using four-point fixation technique with suture anchors under arthroscopy at Department of Sports Medicine,The Affiliated Hospital to Qingdao University from January 2015 to December 2018.They were 33 males and 25 females,with an average age of 18.4 years(from 14 to 32 years).By the modified Meyers-McKeever classification,15 fractures were typeⅡ,19 typeⅢand 24 typeⅣ.Recorded and compared were knee Lysholm scores,International Knee Documentation Committee(IKDC)scores and tibial eminence height between preoperation and one year postoperation;recorded at the last follow-up were range of knee motion and results of Lachman and pivot-shift tests.Results The 58 patients were followed up for a mean of 20.7 months(from 12 to 33 months).Bony union was achieved in all patients within 12 weeks after operation.In this cohort,the Lysholm score(85.2±4.9)and IKDC score(86.2±4.3)at one year postoperation were significantly higher than the preoperative values(43.2±5.2 and 51.2±4.9),and the post-operative tibial eminence height[(9.1±1.2)mm]was significantly lower than the preoperative value[(12.6±1.2)mm](all P<0.05).The correlation coefficients between the tibial eminence height and the Lysholm&IKDC scores at one year postoperation were-0.16 and-0.17,respectively.The last follow-up showed a 132°±5°range of knee motion for all patients,a positive result of pivot-shift test(gradeⅡ)for 3 and a positive result of Lachman test(gradeⅠ)for 2.Conclusion Arthroscopic treatment of tibial eminence avulsion fracture by four-point fixation with suture anchors can lead to satisfactory effectiveness,showing advantages of minimal invasion,anatomic reduction,reliable fixation,and little impact on the epiphysis plate.