膝关节镜下双锚钉四向缝合治疗胫骨髁间嵴撕脱骨折24例

24 Cases of Clinical Study on 4-Direction Suture with Double Anchor under Knee Arthroscope in the Treatment of Patients with Avulsion Fracture of Tibial Intercondylar Eminence

目的:探讨膝关节镜下双锚钉4向缝合技术治疗胫骨髁间嵴撕脱骨折的临床疗效。方法:2017年1月至2020年1月共收治胫骨髁间嵴撕脱骨折患者24例,其中运动伤12例,交通事故伤7例,摔伤5例;男16例,女8例;年龄19~51岁,平均32.2岁;右侧14例,左侧10例。胫骨髁间嵴撕脱骨折的Meyers-McKeever分型:Ⅰ型1例,Ⅱ型11例,Ⅲ型8例,Ⅳ型4例。前抽屉试验及Lachma试验均呈阳性,Lysholm评分为(51.6±4.6)分,国际膝关节文献委员会(IKDC)2000主观膝关节评分为(57.1±3.3)分。受伤至手术时间为3~18 d,平均8.5 d。结果:术后切口均Ⅰ期愈合,无血管神经损伤。患者均获随访,随访时间6~28个月,平均16个月。术后即刻X线片检查示胫骨髁间嵴撕脱骨折复位良好,3个月及12个月后CT及MRI检查示髁间嵴骨折均愈合,前抽屉试验及Lachman试验阴性,患肢膝关节活动范围达0°~135°;Lysholm评分为(92.6±3.2)分,IKDC2000主观膝关节评分为(92.3±4.8)分,Lachman和Lysholm评分与术前比较差异均有统计学意义(t1=21.200,t2=20.500,P<0.001)。结论:膝关节镜下双锚钉四向缝合治疗胫骨髁间嵴撕脱骨折复位精准、创伤小、操作简便,无需二次取内固定装置,是值得推荐的一种手术技术。

Objective:To investigate the clinical efficacy of 4-way suture with double anchors under knee arthroscopy in the treatment of tibial intercondylar ridge avulsion fracture.Methods:There were 24 cases of tibial intercondylar ridge avulsion fracture from January 2017 to January 2020.12 cases were sports injury.7 cases were traffic accident injury and 5 cases were fall injury.There were 16 males and 8 females.The average age was 32.2 years old(19 to 51 years old).The affected side of 14 cases was on the right side and 10 cases was on the left side.According to the Meyers-McKeever classification of tibial intercondylar ridge avulsion fracture,there were 1 case of typeⅠ,11 cases ofⅡtype,8 cases of typeⅢand 4 cases of typeⅣ.The Lysholm score of anterior drawer test and Lachma test were positive,and the(IKDC)2000 subjective knee score of the International Knee Joint Literature Committee was 57.1±3.3.The time from injury to operation was 3 to 18 d,with an average of 8.5 d.Results:All the incisions healed in the first stage after operation,and there was no vascular and nerve injury.All patients were followed up for 16 months(6 to 28 months).X-ray examination immediately after operation showed that the avulsion fracture of tibial intercondylar ridge had a good reduction.Three months and one year later,CT and MRI examination all showed that the intercondylar ridge fracture healed,the anterior drawer test and Lachman test were negative,the range of motion of the affected knee joint was 0°~135°.the Lysholm score was 92.6±3.2,and the IKDC2000 subjective knee score was 92.3±4.8.There were significant differences in Lachman and Lysholm scores compared with those before operation(t1=21.200,t2=20.500,P<0.001).Conclusion:4-way suture with double anchors under knee arthroscopy in the treatment of tibial intercondylar ridge avulsion fracture has the advantages of accurate reduction,less trauma,simple operation and no need for secondary internal fixation.It is a recommended surgical technique.