关节镜下缝线“8”字打结空心钉固定治疗前交叉韧带胫骨止点撕脱性骨折

目的探讨关节镜下缝线“8”字打结、空心钉固定治疗前交叉韧带（ACL）胫骨止点撕脱性骨折的可行性及近期疗效。方法对15例ACL胫骨止点撕脱性骨折行关节镜下ACL胫骨止点缝合及空心钉固定术,采用在关节镜下结合常规关节镜人路和经髌腱人路进行骨折复位固定,术中使用双根5号Ethibond聚乙烯缝线,在韧带下方、骨块上方经前内侧人路从后往前拢住韧带,并打结呈“8”字形,经韧带两侧胫骨骨隧道拉到胫骨内下方。在骨隧道下方2cm处打入带垫圈的直径4．5mm空心钉,做后抽屉试验,同时拉紧固定线,复位骨块,将固定线固定于空心钉垫圈下,拧紧空心钉。结果手术时间40～60min,平均50min。15例随访6～18个月,平均12个月。术后6周,所有骨折均获愈合,未出现移位。术后3个月,1例有I度前抽屉试验阳性,其余患者均为阴性。所有患者屈伸膝活动度正常。术后半年Lysholm膝关节功能评分90～96分。结论关节镜下缝线“8”字打结空心钉固定治疗ACL胫骨止点撕脱性骨折,术中关节镜监控可靠,操作简便,效果满意,值得推广。     

关节镜下治疗后交叉韧带胫骨止点撕脱性骨折近期疗效观察

[目的]探讨关节镜下缝线空心钉固定治疗后交叉韧带胫骨止点撕脱性骨折的可行性及近期疗效.[方法]对10例后交叉韧带胫骨止点撕脱性骨折行关节镜下PCL胫骨止点缝合及空心钉固定术.术中使用2根5号Ethi-bond聚乙烯缝线,在韧带下方骨块上方从前往后拢住韧带,经韧带两侧胫骨骨隧道拉到胫骨内下方.在骨隧道下方2 cm处打入带垫圈的直径4.5mm空心钉.[结果]手术时间60～90 min,平均75 min.10例均随访12～18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.无胭窝部神经、血管损伤并发症.术后半年Lysholm膝关节功能评分83～95分(89.6±4.03)分.[结论]关节镜下通过双后内侧入路缝线空心钉固定治疗后交叉韧带胫骨止点撕脱性骨折,术中关节镜监控可靠,操作简便,效果可靠,值得推广.     

关节镜下前交叉韧带胫骨止点撕脱性骨折病理解剖观察与手术技术选择

目的观察关节镜下前交叉韧带（ACL）胫骨止点撕脱性骨折移位的病理解剖与手术技术选择的关系。方法对23例ACL胫骨止点撕脱性骨折行关节镜下观察,明确骨折移位情况及骨折端难以手术复位的原因。采用在关节镜下结合常规关节镜入路和经髌腱入路进行骨折复位固定。使用双根5号Ethibond聚乙烯缝线将ACL环绕,缝合线引到胫骨平台下打结并结合空心钉固定打结线。结果23例撕脱骨折面均不平整,骨折两端间存留碎骨片及血凝块嵌入16例、膝横韧带嵌入7例、髌下滑膜嵌入4例、内侧半月板前角嵌入5例。14例Ⅲ型骨折中13例撕脱骨折块除与ACL相连外,还与外侧半月板前角相连,骨块向上外明显移位。手术时间40～60（50±6.46）min。23例均获随访,时间10～26（15±3.95）个月。术后3个月骨折均获愈合,未出现骨折移位。根据Lysholm膝关节功能评分：术前19～42（30.13±6.36）分;术后6个月90～98（93.91±2.56）分（t=49.92,P〈0.01）。结论移位的ACL胫骨止点撕脱性骨折块不仅与ACL相连,而且绝大部分还与外侧半月板前角相连,两者力学作用方向不同是其难以复位的主要原因。关节镜下缝线8字打结空心钉固定治疗ACL胫骨止点撕脱性骨折疗效确切。     

关节镜下缝线固定治疗后交叉韧带胫骨止点撕脱骨折

目的探讨关节镜下缝线固定治疗后交叉韧带胫骨止点撕脱骨折的疗效。方法选择膝关节前外侧、高位前内侧、后内侧切口,从胫骨外向撕脱处钻一骨道,将2根5号缝线绕过骨块韧带交界处,打结,将缝线引至骨道外并拉紧,用带鞘螺钉将缝线固定于骨道壁。结果术后骨折块均得到复位。随访3个月～1年,骨折均骨性愈合。术后Lysholm膝关节功能评分(97.3±2.4)分。结论关节镜下缝线固定治疗后交叉韧带胫骨止点撕脱骨折,方法简便,创伤小。     

关节镜下空心钉内固定治疗青少年前交叉韧带胫骨止点撕脱骨折

目的探讨膝关节镜下空心钉内固定治疗青少年前交叉韧带(ACL)胫骨止点撕脱骨折的手术方法和疗效。方法对17例ACL胫骨止点撕脱骨折均采用关节镜下前外侧入路单或双枚空心钉内固定。结果 17例均获随访5～24个月,X线片示骨折复位满意,均骨性愈合。末次随访时Lysholm评分92～100分,平均96.7分。结论膝关节镜下单或双枚空心钉内固定前交叉韧带胫骨止点撕脱骨折技术具有微创、便捷、固定可靠的优点,值得推广。     

关节镜下"8"字缝线与克氏针内固定治疗儿童前交叉韧带胫骨止点撕脱骨折的疗效

目的探讨关节镜下"8"字缝线与克氏针内固定治疗儿童前交叉韧带(ACL)胫骨止点撕脱骨折的临床疗效。方法 48例ACL胫骨止点撕脱骨折患儿采用关节镜下"8"字缝线("8"字缝线组,26例)与克氏针内固定(克氏针组,22例)治疗。末次随访时记录膝关节活动度、Lysholm评分和IKDC评分。结果患儿均获得随访,时间12～24个月。两组前抽屉试验及Lachman试验均转为阴性。末次随访时,两组膝关节活动度、Lysholm评分和IKDC评分均高于术前(P 0. 05);两组间3项比较差异均无统计学意义(P 0. 05)。结论关节镜下"8"字缝线与克氏针内固定治疗儿童ACL胫骨止点撕脱骨折疗效相当,而"8"字缝线内固定无骨骺损伤风险,术后无需取出。     

经后纵隔关节镜下修复后交叉韧带胫骨止点撕脱骨折

目的 探讨经后纵隔关节镜下后交叉韧带(PCL)胫骨止点撕脱骨折修复术的方法和临床疗效.方法 对58例PCL胫骨止点撕脱骨折,采用经后纵隔关节镜下手术,运用缝线"锁扣"固定.结果 术后6周骨折基本愈合,6个月伸膝功能均正常,5例患者残留有10～20°屈曲受限,3例后抽屉试验Ⅰ度阳性.Lysholm膝关节功能评分为(92.3±3.1)分.结论 经后纵隔关节镜下缝线"锁扣"固定后交叉韧带胫骨止点撕脱骨折,创伤小、操作简便、疗效良好.     

关节镜下应用不吸收逢线固定治疗急性后交叉韧带胫骨止点撕脱性骨折

目的 探讨关节镜下应用不吸收逢线捆扎后交叉韧带胫骨端并经胫骨双隧道复位固定撕脱骨折块的临床应用效果.方法 在关节镜下应用不吸收缝线固定治疗急性后交叉韧带胫骨止点撕脱性骨折16例.结果 16例随访时间平均6.5个月(3～15个月);术后3个月骨折均愈合,无再移位,膝关节活动范围均超过120°,无伸膝受限;后抽屉试验Ⅰ度阳性1例,其余为阴性;Lyshlon评分(91.6±3.5)分.结论 关节镜下应用不吸收逢线固定治疗急性后交叉韧带胫骨止点撕脱性骨折方法 可靠,可有效恢复膝关节功能.     

关节镜下缝线套扎治疗胫骨髁间嵴撕脱性骨折

目的 探讨关节镜下缝线套扎治疗前交叉韧带胫骨止点处髁间嵴撕脱性骨折的手术方法及其临床疗效.方法 自2006年7月～2009年11月,对19例前交叉韧带胫骨止点处髁间嵴撕脱性骨折在关节镜下应用缝线套扎治疗.结果 术后随访9～48个月,平均25.7个月.术后3个月X线片查示骨折均愈合.17例前抽屉试验、Lachman试验查...     

关节镜下带线锚钉固定修复Meyers McKeever Ⅲ型前交叉韧带胫骨止点撕脱骨折

目的探讨前交叉韧带胫骨止点撕脱骨折在关节镜下使用带线锚钉固定的手术疗效。方法 2012年5月~2013年7月,对15例Meyers Mc KeeverⅢ型前交叉韧带胫骨止点撕脱性骨折,在关节镜下使用带线锚钉固定,术后早期功能锻炼,术后复查X线片了解骨折复位愈合情况,检查膝关节松弛度、活动度。结果随访12~22个月,平均17个月。15例前交叉韧带胫骨止点撕脱性骨折均满意复位愈合,无移位,术后Lachmann试验及前抽屉试验均阴性,膝关节功能正常。术前Lysholm评分(54.2±4.2)分,术后12个月提高至(91.8±2.2)分(配对t检验,t=2.242,P=0.000)。结论关节镜下应用带线锚钉固定治疗前交叉韧带胫骨止点撕脱性骨折,手术疗效满意,具有复位良好,固定牢靠,可早期行膝关节功能锻炼,缩短术后康复周期,避免膝关节僵硬,对于前交叉韧带止点撕脱骨折是一种可靠的方法。     

Posterior approach for arthroscopic reduction and antegrade fixation of avulsion fracture of the posterior cruciate ligament from the tibia with cannulated screw and washer

Avulsion fracture of the posterior cruciate ligament (PCL) is a rare condition, and arthroscopically assisted reattachment of the surgical fixation of the fragment is not always an easy task. Only a few reports describe techniques for arthroscopic fixation of avulsion of the PCL.We report on a case treated arthroscopically with reduction and antegrade fixation of an avulsion fracture of the tibial attachment of the PCL with a cannulated screw and washer through an additional posterolateral portal. Postoperative morbidity was reduced, and rehabilitation was accelerated. Fixation with a cannulated screw and washer is technically simple and allows for stable fixation and immediate postoperative mobilization and pain-limited weight-bearing, even in cases of a comminuted fragment. The safe zone for an additional posterolateral portal and the technique for placing instruments and a guidewire to avoid neurovascular structures is defined.     

Fixation of small tibial avulsion fracture of the posterior cruciate ligament using the double bundles pull-through suture method.

BACKGROUND: Avulsion of the tibial insertion of the posterior cruciate ligament is commonly repaired via open reduction and internal fixation with a screw, Kirschner's wire, and suture. In the case of a major bony fragment, this technique is adequate to achieve rigid fixation. In the case of an avulsion fracture with a small bony fragment, however, it is not uncommon to break the bone fragment during screw fixation. We describe a new technique for fixation of an avulsion fracture with a small bony fragment. The technique uses a double bundles pull-through suture technique that repairs the anterolateral and posteromedial components of the posterior cruciate ligament simultaneously. METHODS: From March 1994 through May 1997, 12 patients with small tibial avulsion fractures of the posterior cruciate ligament were treated using this technique. RESULTS: At an average of 18 months after surgery (range, 12-24 months), the preliminary clinical and radiographic results were satisfactory. Eleven patients could return to the same or a higher level of preinjury sports activity. According to the International Knee Documentation Committee rating system, 10 of the 12 patients had normal or nearly normal ratings. CONCLUSION: The double bundles pull-through suture technique can avoid the risk of breakage of the small bony fragment, does not require the removal of hardware, and can achieve adequate repair in the anatomic situation. Our clinical experience suggests that it is a good choice for fixation in cases of avulsion fracture with a small bony fragment.     

Arthroscopic suture fixation for bony avulsion of the posterior cruciate ligament

We describe a new arthroscopic technique for suture fixation of a posterior cruciate ligament (PCL) avulsion fracture from the tibia. This technique is indicated when the size of the avulsed fragment is small and fixation with a screw or pins is inadequate. Three portals are used: a parapatellar anteromedial portal, a high posteromedial portal, and a posterolateral portal. Using a PCL tibial guide, 2 bone tunnels are made from the anterior cortex of the tibia to the medial and lateral border of the avulsed site. One or 2 strands of 23-gauge wire or multiple nonabsorbable sutures are used for fixation through the tunnels. If the bony fragment is small or comminuted, fixation with wires or sutures leads to rigid fixation and early rehabilitation.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 17, No 7 (September), 2001: pp 776–780     

Arthroscopic treatment of a PCL avulsion fracture in a skeletally immature patient

Posterior cruciate ligament (PCL) avulsions from the tibial attachment site in children are rare. Six cases have been reported in the English literature since 1975. Osteochondral avulsions of the PCL can be easily missed on plain radiographs in skeletally immature patients because of the rarity of these injuries and open proximal tibial physis. To properly recognize and treat the condition, careful physical examination and adequate imaging studies are crucial. Few case reports demonstrate successful surgical treatment of the injury using screw fixation. This article presents a case of a 13-year-old girl with tibial avulsion of the PCL treated by arthroscopic reduction and pull-out suture, sparing the epiphyseal plate using a posterior transseptal portal. The proximal substance of the avulsed PCL was grasped with a suture hook introduced from posterolateral to posteromedial rather than through the small, fragmented bony portion. The suture material was passed and retrieved through the bony tunnel from posterior to anterior above the epiphyseal plate. Although it has not been proven yet in terms of biomechanical benefit, we believe this alternative treatment to PCL avulsion injuries in skeletally immature patients will provide sufficient strength to maintain ligament tension during the healing process and avoid physeal injury.     

关节镜下复位缝合锚钉固定治疗前交叉韧带胫骨止点撕脱骨折的临床效果分析

目的 探讨关节镜下复位缝合锚钉固定治疗前交叉韧带胫骨止点撕脱骨折的临床效果.方法 回顾26例关节镜下复位缝合锚钉固定治疗前交叉韧带（Anterior Cruciate Ligament,ACL）胫骨止点撕脱骨折,观察骨折复位、愈合情况,膝关节的活动度及稳定性及Lysholm评分等.结果 本组26例均获随访,随访时间6～36个月.骨折均为解剖复位及近解剖复位,且均为骨性愈合.关节活动度用Lysholm评分,术前平均（7.7±1.5）分,术后平均（95.6±5.3）分.关节稳定性用KT2000检查结果均正常,前抽屉试验、Lachman试验、轴移试验均阴性.结论 关节镜下复位缝合锚钉固定治疗ACL胫骨止点撕脱骨折创伤小,固定牢靠,可恢复前交叉韧带长度及强度,早期功能锻炼,功能恢复良好,且不需取出内固定.     

关节镜下两种固定方式治疗前交叉韧带止点撕脱骨折的疗效比较

目的比较关节镜下空心螺钉和不可吸收缝线固定前交叉韧带止点撕脱骨折的临床疗效。方法回顾分析2002年1月-2009年1月关节镜下治疗并获2年以上随访的43例前交叉韧带止点撕脱骨折患者临床资料,骨折Meyers-McKeever-Zaricznyj分型均为Ⅱ型或Ⅲ型。其中21例采用空心螺钉固定(空心螺钉组),22例采用不可吸收缝线固定(缝线组)。两组患者性别、年龄、病程、骨折分型等一般资料比较,差异均无统计学意义(P>0.05),具有可比性。比较术后两组患者膝关节活动度和Lysholm评分,采用Lachman试验和KT-2000检测评估关节稳定性。结果空心螺钉组手术时间为48～60 min,平均51.6 min,缝线组为55～68 min,平均63.2 min,差异有统计学意义(t=4.645,P=0.032)。两组患者术后切口均Ⅰ期愈合,无感染等早期并发症发生。患者均获随访,随访时间空心螺钉组为(5.7±0.6)年,缝线组为(5.3±0.5)年。术后两组骨折均临床愈合,空心螺钉组骨折愈合时间为(3.3±0.6)个月,缝线组为(3.2±0.4)个月,差异有统计学意义(t=3.723,P=0.019)。末次随访时,空心螺钉组患者关节活动度为(128.6±10.1)°,缝线组为(130.2±14.1)°;屈膝30°KT-2000检测健、患侧胫骨前移差值分别为(0.9±0.3)mm和(1.0±0.4)mm;Lysholm评分分别为(94.6±14.5)分和(95.1±17.2)分;以上指标两组间比较差异均无统计学意义(P>0.05)。结论关节镜下采用空心螺钉和不可吸收缝线固定Meyers-McKeever-ZaricznyjⅡ、Ⅲ型前交叉韧带止点撕脱骨折,均能获得较好疗效,但均有部分患者术后存在5°或10°的膝关节伸直滞缺。     

Arthroscopic Fixation of Avulsion of the Posterior Cruciate Ligament From Femoral Insertion

Femoral avulsion of the posterior cruciate ligament (PCL) is not common, especially in adults. We present a case and an arthroscopic repair technique using 4 transfemoral tunnels; 2 anterior tunnels for fixation of the anterior bundle of the PCL and 2 posterior for the posterior bundle. Our case was that of a femoral avulsion of the PCL associated with tibial avulsion of the anterior cruciate ligament and femoral avulsion of the medial collateral ligament of the left knee in an adult. We repaired the tibial avulsion of anterior cruciate ligament using an arthroscopic transtibial suture technique and the femoral avulsion of the medial collateral ligament by using staple fixation.     

Kindliche kniegelenknahe Avulsionen

Background

Avulsion fractures around the knee in children and adolescents are rare injuries and usually occur during sport activities. This article describes the epidemiology, classification and current treatment strategies for these injuries.

Objective

This article gives an overview of the epidemiology, classification and current treatment concepts of pediatric avulsion fractures around the knee.

Results

The most frequent pediatric avulsion fractures around the knee affect the tibial tuberosity and both the anterior and posterior cruciate ligaments. Bony avulsion of the cruciate ligaments can be classified according to Meyers and McKeever. In many cases there are indications for surgical treatment but non-dislocated fractures can be conservatively treated. Apophyseal fractures of the tibial tuberosity are as a rule repositioned by an open procedure followed by fixation with screws. The options for surgical treatment of bony avulsion of the cruciate ligaments are manifold, ranging from direct open screw fixation to bone anchoring and arthroscopic repositioning with suture cerclage. The advantages of arthroscopic procedures are the possibility to simultaneously treat unilateral accompanying injuries, such as meniscus ruptures.

Conclusion

Non-dislocated pediatric avulsion injuries near the knee can be treated conservatively under regular clinical and radiological follow-up control. Dislocated avulsions and non-dislocated avulsions with accompanying injuries are surgically treated. Arthroscopic procedures should be a standard procedure with respect to bony avulsion of the anterior cruciate ligament. In contrast, bony avulsion of the posterior cruciate ligament and injuries of the tibial tuberosity must be addressed rapidly and effectively with direct open repositioning.

     

关节镜下治疗前交叉韧带胫骨髁间嵴撕脱骨折

目的探讨关节镜下对前交叉韧带胫骨髁间嵴撕脱骨折应用缝合线加钢缆进行复位和内固定的疗效。方法 56例前交叉韧带胫骨髁间嵴撕脱骨折患者(Ⅱ型13例,ⅢA型15例,ⅢB型13例,Ⅳ型15例),关节镜下应用Ethibond X519缝合线加钢缆对胫骨髁间嵴撕脱骨折区进行缝合捆绑,通过胫骨髁前置双隧道牵引复位、固定。结果术后X线片显示胫骨嵴撕脱骨折完全复位。56例均获随访,时间18～21个月。末次随访时骨折完全愈合。Lachmen试验(-)56例;前抽屉试验(-)55例,1例弱阳性。IKDC评定:术前C级30例,D级26例;术后A级55例,B级1例。Lysholm评分:术前37～52(42.7±0.34)分;术后91～96(95.7±0.56)分,平均提高53.0分±0.43分,术前、术后比较差异有统计学意义(P<0.01)。结论关节镜下应用缝合线加钢缆内固定治疗膝关节前交叉韧带胫骨髁间嵴撕脱骨折,可以对移位的撕脱骨折很好地复位,最大限度地加大单位面积上的压力,增加刚性稳定。并可早期功能锻炼。