关节镜下栓桩固定治疗胫骨髁间前棘撕脱骨折

Treatment of avulsion fracture of tibial intercondylar anterior spine with suture fixation under arthroscope

目的探讨关节镜下用钢丝固定与用栓桩技术缝线固定这两种方法治疗前交叉韧带(ACL)胫骨止点撕脱骨折的疗效比较。方法2016年2月至2019年2月共收治胫骨髁间前棘撕脱骨折26例,纳入诊断为Meyers-Mckeever分型Ⅱ~Ⅲ型的单侧新鲜闭合性损伤患者,分为钢丝组15例和栓桩组11例,记录所有患者的手术时间、膝关节活动度(ROM)、Lysholm评分。每月复查X片了解骨折愈合时间。上述结果比较采用独立样本t检验。结果栓桩组平均手术时间(56.8±6.7)min少于钢丝固定组(68.5±5.1)min(t=5.062,P<0.05)。所有患者均得到回访,随访时间6~13个月。钢丝组愈合时间(4.3±0.3)个月,栓桩组为(4.1±0.4)个月(t=1.463,P>0.05);术后3个月Lysholm评分钢丝组(82.4±9.1)分,栓桩组(84.1±9.5)分(t=0.462,P>0.05);术后6月Lysholm评分钢丝组(94.6±7.2)分,栓桩组(93.1±6.4)分(t=0.551,P>0.05);二者差异均无统计学意义。结论关节镜下栓桩技术操作简便、手术时间短,疗效满意。

Objective To explore the comparison of arthroscopic bolted fixation and wire fixation for anterior cruciate ligament tibial avulsion fracture.Methods A series of 26 cases of avulsion fractures of the anterior intercondylar spine of the tibia were treated from February 2016 to February 2019.Inclusion criteria were as follows:Meyers-McKeever classification II-III based on three-dimensional CT reconstruction;unilateral fresh closed injury.The patients were divided into the wire group(n=15)and the bolted group(n=11).The operative time,range of motion(ROM)and Lysholm score of all the patients were recorded.Monthly X-ray examination was conducted to determine the fracture healing time.The results were compared by independent t test.Results The mean operation time of the bolted group was(56.8±6.7)min,and that of the wire group was(68.5±5.1)min.The operation time of the bolted group was significantly shorter(t=5.062,P<0.05).All the patients were followed up for six to 13 months.The healing time of wire group was(4.3±0.3)months,and that of bolted group was(4.1±0.4)months(t=1.463,P>0.05).Lysholm score at three month post-operatively in the wire group was(82.4±9.1),and that in the bolted group was(84.1±9.5)(t=0.462,P>0.05).Lysholm score was(94.6±7.2)in the wire group and(93.1±6.4)in the bolted group six months after operation(t=0.551,P>0.05).There was no statistical difference.Conclusion Arthroscopic bolting post technique is easy to actualize withless operation time and good result.