非镜下技术治疗胫骨平台骨折合并前交叉韧带髁间止点骨折

Review of the Efficacy of Open Reduction and Internal Fixation Combined with Non-Endoscopic Technique in theTreatment of Tibial Plateau Fracture Combined with Anterior Cruciate Ligament Intercondylar Ridge Fracture

目的总结微创切口结合切开复位内固定技术治疗胫骨平台骨折合并前交叉韧带髁间嵴止点骨折手术操作要点及近期疗效观察。方法选择2019年1月至2021年1月期间上海交通大学医学院附属新华医院收治的25例合并前交叉韧带止点部撕脱骨折的胫骨平台骨折患者为研究对象,男17例,女8例;年龄38~55岁,平均(45.74±5.63)岁;胫骨平台骨折分型SchatzkerⅡ~V型;前交叉韧带髁间嵴止点骨折手术分型Meyers-McKeeverⅡ~Ⅳ型。手术均以胫骨平台切开复位钢板内固定结合膝前髌韧带内侧纵行切口,采用缝合钩过线技术结合隧道固定技术将前交叉韧带连同髁间嵴止点骨折块坚强固定。统计术后不良反应发生情况,并在末次随访时采用Lysholm评分、国际膝关节文献委员会(international knee documentation committee,IKDC)评分、Tegner评分以及美国特种外科医院(the hospital special surgery,HSS)评分来综合评价膝关节功能。结果25例患者均手术顺利,术后随访12~18个月,平均(14.5±2.1)个月。骨折均临床愈合,其中1例患者出现术后切口脂肪液化,经清创换药、引流,后经Ⅱ期缝合后痊愈,其余患者伤口均为Ⅰ期愈合。1例患者术后2个月出现膝关节僵硬,经静脉麻醉下手法松解,活动度逐渐恢复正常。2例患者发生膝关节创伤性关节炎,经口服非甾体抗炎药后症状改善。末次随访时,患者膝关节伸直均达到0°,屈膝100°~135°,平均(118.45±15.36)°。膝关节功能评分:Lysholm评分(82.35±5.63)分,IKDC评分(85.67±6.44)分,Tegner评分(5.75±0.54)分,HSS评分(83.43±8.87)分,其中HSS评分优15例,良7例,中3例,优良率88%,膝关节功能恢复良好。结论对于胫骨平台骨折合并前交叉韧带髁间嵴止点骨折的患者,采用切开复位内固定结合髌前微创切口非镜下过线隧道技术,可实现一期固定前交叉韧带止点骨折块,有助于早期开展膝关节功能康复锻炼,有利于患肢功能尽早恢复,减少并发症。

Objective To summarize the operation points and short-term curative effect of minimally invasive incision combined with open reduction and internal fixation in the treatment of tibial plateau fracture combined with anterior cruciate ligament intercondylar ridge fracture.Methods 25 patients[17 males,8 females,38 to 55 years old,mean age(45.74±5.63)years]with tibial plateau fracture complicated with avulsion fracture of anterior cruciate ligament insertion point treated in the Department of Orthopaedics of Shanghai Jiaotong University School of Medicine Affiliated Xinhua Hospital from January 2019 to January 2021 were selected as the research objects.The classification of tibial plateau fracture was SchatzkerⅡ~Ⅴ,and the surgical classification of anterior cruciate ligament intercondylar ridge insertion fracture was Meyers McKeeverⅡ~Ⅳ.Open reduction and internal fixation of tibial plateau with steel plate combined with medial longitudinal incision of patellar ligament were implemented in all operations.The anterior cruciate ligament and the fracture block at the insertion point of intercondylar crest were firmly fixed by suture technique combined with tunnel fixation technique.The incidence of postoperative adverse reactions was counted,and Lysholm score,International knee documentation committee,international knee documentation committee(IKDC)score,Tegner score and the hospital special surgery(HSS)score were used to comprehensively evaluate the knee function at the last follow-up.Results All patients underwent successful operation.After follow-up for 12 to 18 months,with an average of(14.5±2.1)months.The fractures were clinically healed.One patient had postoperative incision fat liquefaction,which was cured after debridement,dressing change and drainage,followed by second stage suture,and the wounds of other patients were healed in phaseⅠ.One patient developed knee stiffness 2 months after operation,which was released manually under intravenous anesthesia,and the range of motion gradually returned to normal.Two patients developed traumatic arthritis of knee joint,and their symptoms improved after oral nonsteroidal anti-inflammatory drugs.At the last follow-up,all patients had knee straightening of 0°,knee flexion of 100°to 135°,with an average of(118.45±15.36)°.Lysholm score was(82.35±5.63).IKDC score was(85.67±6.44).Tegner score was(5.75±0.54).HSS score was(83.43±8.87),and it was excellent in 15 cases,dood in 7 cases,medium in 3 cases and poor in 0 case.The excellent and good rate was 88%.Conclusion For patients with tibial plateau fracture combined with anterior cruciate ligament intercondylar ridge fracture,open reduction and internal fixation combined with anterior patellar minimally invasive incision and non-microscopic line crossing tunnel technology can realize one-stage fixation of anterior cruciate ligament stop fracture block,which is conducive to early knee function rehabilitation exercise,early recovery of affected limb function and reduction of complications.