关节镜下两种固定方式治疗Ⅱ、Ⅲ型前交叉韧带胫骨止点撕脱骨折的疗效比较

Comparison of the effect of two arthroscopy fixation methods on Ⅱ,Ⅲ anterior cruciate ligament tibial avulsion fractures

目的对比关节镜下采用缝线固定与空心螺钉固定Ⅱ、Ⅲ型前交叉韧带胫骨止点撕脱骨折的临床疗效。方法选取本院从2013年1月~2017年1月期间收治的Ⅱ、Ⅲ型前交叉韧带胫骨止点撕脱骨折60例患者,以随机数字表法分为关节下缝线固定组(A组)和关节下空心螺钉固定组(B组),每组各30例。比较两组患者手术时间、膝关节活动度(ROM)、Lysholm膝关节功能评价量表(LKS评分)及患健侧位移差值。结果经24个月的随访,A组和B组患者平均骨折愈合时间分别为(6.42±1.35)个月和(6.39±0.97)个月,两组相比较差异无统计学意义(P>0.05)。所有患者术后Lachman及前抽屉试验阴性;其中B组手术时间明显低于A组(P<0.05);两组患者膝关节ROM、LKS评分及患健侧位移差值比较差异无统计学意义(P>0.05)。结论关节镜下采用缝线固定与空心螺钉固定Ⅱ、Ⅲ型前交叉韧带胫骨止点撕脱骨折的两种手术方式均能使骨折获得骨性愈合、有效改善膝关节活动功能及恢复膝关节稳定性,但关节镜下空心螺钉固定手术时间较短,操作难度较低。

Objective To compare the clinical effect of arthroscopic suture and cannulated screw fixation in the treatment ofⅡ,Ⅲanterior cruciate ligament tibial avulsion fractures at tibial insertion.Methods From January 2013 to January2017,60 patients withⅡ,Ⅲanterior cruciate ligament tibial avulsion fractures in our hospital were selected and randomly divided into sub-articular suture fixation group(group A)and Sub-articular cannulated screw fixation group(group B)by random number table method,30 cases in each group.The operation time,ROM of the knee joint,Lysholm knee function evaluation scale(LKS score)and the difference of the affected side were compared between the two groups.Results All the patients were followed up for 24 months.The average fracture healing time of group A and group B were(6.42±1.35)months and(6.39±0.97)months respectively,and there was no significant difference between the two groups(P>0.05).Lachman and anterior drawer test were negative.The operation time of group B was significantly lower than that of group A(P<0.05).There was no significant difference in LKS score,ROM and displacement of healthy side between the two groups(P>0.05).Conclusion Arthroscopic suture fixation and cannulated screw fixation can achieve osseous healing,improve the function of joint movement and restore the stability of the joint for the treatment ofⅡ,Ⅲanterior cruciate ligament tibial avulsion fractures,however,the operation time of cannulated screw fixation is shorter and the operation difficulty is lower.