关节镜下可收紧钛板套扎固定前交叉韧带胫骨止点撕脱骨折的早期疗效研究

Early effect of arthroscopic fixation for tibial avulsion fracture of anterior cruciate ligament with tightening titanium plate

目的:探讨关节镜下运用可收紧钛板套扎固定技术治疗前交叉韧带(ACL)胫骨止点撕脱骨折的早期疗效。方法:2017年1月至2019年12月,收治5例ACL胫骨止点撕脱骨折患者,其中男4例,女1例;年龄21~49岁,平均(34.2±11.2)岁。所有患者接受关节镜下可收紧钛板套扎固定术复位并固定骨折块。评估并记录围手术期并发症。通过术后至少1年的随访,以Lachman试验、前抽屉试验及轴移试验评估患者膝关节稳定性,以国际膝关节文献委员会(IKDC)评分及Lysholm评分评估患者膝关节功能。结果:患者平均手术时间(57.2±13.3)min,平均住院时间(6.6±2.1)d。手术切口均一期愈合。患者均完成术后12个月的随访。术后前抽屉试验、Lachman试验及轴移试验均为阴性。术后3个月及末次随访时,IKDC评分分别为(84.0±3.2)分和(87.6±1.7)分,Lysholm评分分别为(89.0±2.2)分和(89.4±0.9)分,均较术前[IKDC评分(33.6±5.2)分,Lysholm评分(42.6±3.3)分]明显升高(P<0.001)。所有患者末次随访时骨折均达骨性愈合,其中解剖复位4例、接近解剖复位1例。所有患者无切口愈合不良、神经血管损伤、下肢深静脉血栓、肺栓塞、围手术期死亡等并发症发生。结论:采用关节镜下可收紧钛板套扎固定技术治疗ACL胫骨止点撕脱骨折,可有效恢复膝关节稳定性,改善关节功能,早期疗效满意。

Objective:To investigate the early effect of arthroscopic treatment for tibial avulsion fracture of anterior cruciate ligament(ACL)with tightening titanium plate.Methods:From January 2017 to December 2019,5 patients with ACL tibial avulsion fracture were treated,including 4 males and 1 female with the average age of(34.2±11.2)years(rang,21-49 years).All patients underwent arthroscopic tightening titanium plate ligation to reduce and fix fracture blocks.Perioperative complications were evaluated and recorded.Knee joint stability was evaluated by Lachman's test,anterior drawer test and pivot shift test,and knee joint function was evaluated by International Knee Documentation Committee(IKDC)score and Lysholm score at least one year after operation.Results:The average operation time was(57.2±13.3)min and the average hospitalization period was(6.6±2.1)days.All patients had primary incision healing.All patients were followed up for 12 months.The anterior drawer test,Lachman's test and pivot shift test were all negative.At 3 months after operation and the last follow-up,the IKDC scores were(84.0±3.2)and(87.6±1.7)respectively,and the Lysholm scores were(89.0±2.2)and(89.4±0.9)respectively,which were significantly higher than those before operation[IKDC score(33.6±5.2),Lysholm score(42.6±3.3),P<0.001].All patients achieved bone healing at the last follow-up,including 4 cases of anatomical reduction and 1 case close to anatomical reduction.All patients had no complications as poor wound healing,neurovascular injury,lower limb deep vein thrombosis,pulmonary embolism and perioperative death.Conclusions:The treatment of ACL tibial avulsion fracture by arthroscopic tightening titanium plate fixation can effectively restore the stability of knee joint and improve joint function.The early curative effect is satisfactory.