镜下改良克氏针固定儿童胫骨髁间棘骨折

A modified Kirschner wire fixation under arthroscopy for intercondylar tibial eminence fractures in children

[目的]介绍在关节镜下应用改良克氏针固定法治疗儿童胫骨髁间棘骨折的手术技术和初步临床结果。[方法]2016年9月—2019年3月,本院采用关节镜下经皮克氏针复位固定胫骨髁间棘骨折共18例。镜下清创,复位胫骨髁间棘骨折块。在前交叉韧带导向器引导下,将2枚克氏针在胫骨结节内侧及外侧分别经皮钻入,穿过骨折块。镜下使用持针器夹持克氏针尖下约0.5 cm,折弯克氏针约90°,然后回抽拉紧,使骨折块加压固定。[结果] 18例骨折在3个月内均获得愈合,未见骨不连、畸形愈合、针道感染等并发症。末次随访患膝Lysholm功能评分平均为(92.91±6.65)分。[结论]此改良后关节镜下经皮克氏针固定是治疗儿童胫骨髁间棘骨折简单有效的方法。

[Objective] To introduce the surgical technique and preliminary clinical results of a modified Kirschner wire fixation under arthroscopy for the treatment of tibial intercondylar eminence fractures in children. [Methods] From September 2016 to March 2019, a total of 18 children had tibial intercondylar eminence fractures reduced arthroscopically and fixed by modified percutaneous Kirschner wires.Under arthroscope, the fracture site was debrided, and then the tibial intercondylar eminence fracture blocks were reduced. With the guidance of the anterior cruciate ligament guider, 2 Kirschner wires were drilled percutaneously through the medial and lateral sides of the tibial tubercle, and passed through the fracture block. Under arthroscope, the Kirschner wires were bended about 90 degrees at 0.5 cm below the tip by using a needle holder, and then wires were pull back tightly to have the fracture block compressed and fixed. [Results] All 18 children got fracture healing within 3 months, with no complications such as nonunion, malunion, and tract infection. The Lysholm score at the latest follow-up was(92.91±6.65). [Conclusion] This modified arthroscopic percutaneous Kirschner wire fixation is a simple and effective treatment for tibial intercondylar eminence fracture in children.