螺钉结合锚钉固定治疗后交叉韧带胫骨止点撕脱骨折

目的探讨螺钉结合锚钉固定后交叉韧带(posterior cruciate ligament,PCL)胫骨止点撕脱骨折的临床疗效。方法自2009年6月至2012年6月对22例PCL胫骨止点撕脱骨折患者,采用膝关节后内侧入路切开复位,以空心螺钉联合锚钉内固定治疗,术后膝关节支具伸直位固定保护下,早期开始循序渐进的伸屈膝关节功能锻炼。结果本组22例患者随访时间5~22个月,平均12个月。术后12周X线片示所有患者撕脱骨折均获骨性愈合,未见骨折端明显移位。术后6个月按Lysholm膝关节功能评分标准评定,优18例,良3例,可1例,优良率95.5%。结论膝后内侧入路应用空心螺钉结合锚钉内固定治疗PCL胫骨止点撕脱骨折可有效地重建膝关节稳定性,早期功能锻炼,恢复膝关节功能。     

后内侧入路锚钉系统治疗后交叉韧带止点撕脱骨折

目的：评价后内侧入路锚钉系统治疗后交叉韧带止点撕脱骨折的疗效。方法：采用膝后内侧小切口切开复位锚钉系统治疗交叉韧带胫骨止点撕脱骨折21例,依据Lysholm膝关节评分系统评估关节功能。结果：随访时间6-19个月,平均10．3个月,21例均获得骨性愈合,Lysholm膝关节评分73-100分,平均为93．7分。结论：锚钉系统固定治疗后交叉韧带胫骨止点撕脱骨折,具有安全有效、内固定可靠、并发症低等优点。     

改良膝关节后内侧入路治疗后交叉韧带止点撕脱骨折13例回顾分析

目的探讨改良膝关节后内侧入路在治疗后交叉韧带止点撕脱骨折的应用价值。方法对13例后交叉韧带止点撕脱骨折的患者,应用改良膝关节后内侧入路进行切开复位、空心螺钉内固定治疗,术后观察骨折复位情况、愈合时间,采用Lysholm评分法评估术后膝关节功能。结果本组患者术程顺利,13例均获得随访,随访时间6～18个月,平均12个月,Lysholm评分,优9例,良3例,优良率为92.31%。结论改良膝关节后内侧入路显露膝关节后方结构创伤小、安全有效,能较快恢复良好的膝关节功能。     

手术治疗后交叉韧带胫骨止点撕脱性骨折治疗分析

目的 评价应用膝关节后内侧入路治疗后交叉韧带胫骨撕脱骨折的方法及疗效. 方法 回顾分析应用膝关节后内侧切口切开复位、AO空心螺钉置入治疗后交叉韧带胫骨撕脱骨折22例. 结果 本组手术过程顺利,均骨性愈合,术后3个月膝关节活动度均正常.19例均获门诊复查随访,随访时间6～24个月,平均9个月,获得随访的患者骨折术后均Ⅰ期愈合,膝关节活动度均正常,Lysholm评分平均96.6分. 结论 采用膝关节后内侧切口空心钉螺钉固定治疗后交叉韧带胫骨撕脱骨折,手术创伤小,操作简单,固定可靠.     

后内侧入路治疗后交叉韧带胫骨止点撕脱骨折

目的探讨后交叉韧带胫骨止点撕脱骨折的手术入路和固定方法。方法2007年6月至2009年6月对17例后交叉韧带胫骨止点撕脱骨折患者,采用膝关节后内侧入路切开复位,11例用1～2枚空心钛钉固定,6例用钢丝固定。结果17例患者术后随访12-24个月,平均16．4个月,骨折均骨性愈合,术后12个月膝关节功能评定按Hohl评分标准评定,优12例,良3例,可2例,优良率88．2％。结论膝关节的后内侧人路为骨折的直视复位和固定提供了良好的操作空间,结合空心钉或钢丝内固定是治疗后交叉韧带胫骨止点撕脱骨折的一种有效方法。     

后交叉韧带胫骨撕脱性骨折的手术治疗

目的 评价膝后内侧入路治疗后交叉韧带胫骨撕脱性骨折的临床疗效.方法 对于后交叉韧带胫骨撕脱性骨折,采用膝后内侧入路显露,采用空心螺钉或聚乙烯线捆绑固定骨折块,术后支具固定,早期行功能训练.结果 12例病例术后6周所有病例均显示骨性愈合,无骨折块移位.术后3月复查后抽屈试验均为阴性.按膝关节膝关节韧带损伤治疗效果判定标准(JOA),优良率为92%.无血管、神经损伤、关节液漏等并发症.结论 膝后内侧入路显露后交叉韧带胫骨撕脱性骨折,采用空心螺钉或聚乙烯线捆绑固定骨折块,手术创伤小,操作简单,固定可靠.     

改良Burks-Schaffer入路治疗后交叉韧带胫骨止点撕脱骨折

目的探讨后交叉韧带胫骨止点撕脱骨折手术治疗的临床疗效。方法使用改良Burks-Schaffer入路切开复位空心螺钉内固定治疗16例后交叉韧带胫骨止点撕脱骨折。结果手术时间35~55 min。16例均获随访,时间7~15个月。骨折均愈合良好,无再移位发生。平均Lysholm评分:从术前53.2分±3.2分提高至末次随访时95.6分±4.3分(P0.05)。结论改良Burks-Schaffer入路治疗后交叉韧带胫骨止点撕脱骨折可小切口快捷显露骨折区域,空心螺钉固定骨折可靠满意。     

小切口微创治疗单纯后交叉韧带胫骨止点撕脱骨折

目的探讨小切口微创治疗后交叉韧带胫骨止点撕脱骨折的手术方法及疗效。方法对32例后交叉韧带胫骨止点撕脱骨折,采用膝关节后内侧小切口入路治疗。结果术后骨折均一期愈合,1例有Ⅰ度后抽屉试验阳性,2例有10°～15°的屈膝受限,Lysholm膝关节功能评分(91.6±3.6)分。结论采用膝关节后内侧小切口入路治疗后交叉韧带胫骨止点撕脱骨折,避开了膝关节后方神经、血管,有安全,创伤小,术后功能恢复快等优点。     

关节镜下空心螺钉固定治疗后交叉韧带胫骨止点撕脱骨折

目的探讨关节镜下后内侧入路中空螺钉固定治疗后交叉韧带胫骨止点撕脱性骨折的手术技巧及疗效。方法对15例后交叉韧带胫骨止点撕脱性骨折行关节镜下复位经后内侧入路,克氏针临时固定,经克氏针置入单枚带垫片直径4.5 mm中空钛质螺钉固定。结果手术时间40～82 min,平均55 min。随访6～24个月,平均15个月。术后6周,所有骨折均获愈合,未出现骨折移位。无窝部神经、血管损伤并发症。所有患者均无屈伸膝活动受限,仅1例患者后抽屉试验弱阳性。术后半年Lysholm膝关节功能评分89～96分,平均92.5分。结论关节镜下通过后内侧入路带垫片中空螺钉治疗后交叉韧带胫骨止点撕脱性骨折,操作方便、安全,效果可靠。     

膝后正中入路治疗后交叉韧带止点骨折

目的:评价膝后正中入路治疗后交叉韧带止点骨折的疗效。方法:对18例后交叉韧带止点撕脱骨折患者应用膝后正中入路行切开复位、空心螺钉内固定治疗,术后配合中药熏洗,观察骨折复位情况、愈合时间,采用Lysholm评分法评估术后膝关节功能。结果:本组18例均获得随访,随访时间6~18个月,平均12个月;Lysholm评分,优13例,良5例。结论:膝后正中入路治疗后交叉韧带止点骨折,操作简单,安全可靠,疤痕小,手术时间短,配合术后康复锻炼及中药熏洗,能较快地恢复膝关节功能。     

Interfragmentary screw fixation of fractures of the tibial shaft

The records of 54 patients treated with interfragmentary screws were reviewed a mean of 2 years after surgery. Fifty-one fractures were of moderate severity (Ellis, 1950), 31 had a ratio of fracture length to tibial diameter of 2 or more and 17 were comminuted. An anatomical reduction, achieved initially in 44 fractures, was lost before union occurred in 14 (32 per cent), despite plaster splintage. Excellent results, with anatomical healing, were achieved in 30 patients (55 per cent) and good results with less than 5 degrees malalignment in 6 (11 per cent). There was a statistically highly significant association of satisfactory results with initial anatomical operative reduction of the fracture, a ratio of fracture length to tibial diameter of 2 or more and the absence of comminution. The orientation and number of screws, delayed operation, the degree of initial displacement of the fracture and the patient's age were not shown to affect the outcome. Delayed union occurred in 4 patients (7.4 per cent) and non-union in 3 (5.5 per cent). Deep infection occurred twice (3.7 per cent). As more satisfactory results could be expected for these fractures using other techniques, we conclude that this method cannot be recommended.     

Percutaneous screw fixation of tibial plateau fractures.

A series of 13 patients with displaced fractures of the tibial plateau treated by closed reduction and percutaneous pinning have been reviewed 17 months after surgery. All the operations were performed using image intensification to aid reduction of the fracture by ligamentotaxis and to guide screw placement. In two cases, arthroscopy was used in addition to facilitate elevation of the articular surface using a probe inserted through a cortical window in the proximal tibial metaphysis. The postoperative rehabilitation programme consisted of early mobilization and non-weight bearing for at least 2 months. Of the patients, 11 had a satisfactory result, one patient had a fair result with persistent pain and the other had a poor result when the fixation failed in a comminuted bicondylar fracture in porotic bone. This technique is minimally invasive and avoids many of the complications of both conservative and operative treatment and will have an expanding role to play in the management of these fractures.     

关节镜下空心拉力螺钉治疗胫骨髁间棘骨折

<正>2009年1月~2013年1月,我们在关节镜下复位内固定治疗21例胫骨髁间棘骨折患者,疗效良好,报道如下。1材料与方法1.1病例资料本组21例,男13例,女8例,年龄20~45(29.4±7.3)岁。按Meyers-Mckeever标准分型:Ⅱ型7例,Ⅲ型11例,Ⅳ型3例。均为新鲜骨折。术前均常规摄X线片,提示骨骺线闭合,结合患膝CT或MRI诊断明确。合并前交叉韧带(ACL)损伤8例,半月板损伤4例,侧副韧带损伤2例。受伤至手术时间4~12 d。1.2手术方法取膝眼穿刺点进入,关节镜下依顺序探查关节腔内结构(特别     

Pediatric tibial eminence fractures: Arthroscopic cannulated screw fixation

Two pediatric tibial eminence fractures were arthroscopically reduced and fixed with cannulated screws. At 2-year follow-up, anterior tibial translatory laxity was normal and the pivot shift test was negative. In one case, the screw transgressed the proximal tibial physis; however, neither case showed evidence of proximal tibial growth arrest.     

钢板螺钉内固定治疗胫骨骨折的生物力学研究

目的 通过钢板螺钉固定人尸体胫骨标本的生物力学测试分析,为微刨经皮钢板内固定治疗胫骨骨折提供理论依据.方法 选取成人尸体胫骨湿标本40根,随机分成8组,测试载荷-应变指标并进行统计学分析.结果 垂直压缩时垂直方向压力-应变第4组(14孔钢板,固定1、4、7、8、11、14孔)差异有统计学意义;垂直压缩时侧方压力-应变第6组(14孔钢板,固定1、2、7、8、13、14 孔)差异有统计学意义;三点弯曲压缩时垂直方向应变多组差异有统计学意义.结论 ①长钢板垂直方向稳定性及抗扭转稳定性较好;②过多增加螺钉数量并不能增加垂直方向稳定性;③14孔钢板螺钉分布在1、2、7、8、13、14孔时抗扭转稳定性较好;④14孔钢板当螺钉分布为1、3、6、9、12、14孔时三点弯曲压缩稳定性较好.     

空心钉、锚钉内固定治疗膝后交叉韧带胫骨附着部撕脱骨折

目的探讨空心钉、锚钉内固定治疗膝后交叉韧带（PCL）胫骨附着部撕脱骨折的手术疗效。方法对14例单纯PCL胫骨附着部撕脱骨折行切开复位空心钉、锚钉内固定,对合并半月板损伤者术中予以修补,术后早期进行功能锻炼。结果随访6个月～3年,根据Lysholm膝关节评定标准：优10例,良3例,可1例。结论空心钉、锚钉内固定治疗膝PCL胫骨附着部撕脱骨折,操作简便,固定牢靠,疗效满意。     

可吸收螺钉治疗后交叉韧带胫骨附着点撕脱骨折

2009年7月～2011年9月,我们对15例后交叉韧带(PCL)胫骨附着部撕脱骨折患者采用可吸收螺钉固定,效果满意,报道如下。1材料与方法1.1病例资料本组15例,男8例,女7例,年龄26～57岁。患者均行膝关节正、侧位X线片或MRI检查明确诊断,抽屉试验(+)。     

MRI evaluation of the tibial tunnel/screw/tendon interface after ACL reconstruction using a bioabsorbable interference screw

This article describes the complex relationship between graft, bone, and biologic interference screw. Orthopedic surgeons have just begun to understand this complex biologic relationship. Clinical outcome measurements tell very little about the biology in bone tunnels.     

关节镜下空心螺钉内固定治疗胫骨髁间嵴骨折

正2012年7月~2015年1月,我科在关节镜下应用空心螺钉内固定治疗12例胫骨髁间嵴骨折患者,疗效满意,报道如下。1材料与方法1.1病例资料本组12例,男9例,女3例,年龄18~47岁。左侧5例,右侧7例。按Meyers-McKeever分型:Ⅱ型5例,Ⅲ型7例。受伤至手术时间3~