关节镜辅助下治疗成人胫骨髁间棘骨折22例

目的探讨关节镜辅助下成人胫骨髁间棘骨折的微创治疗。方法在2006年1月至2008年5月期间共完成关节镜下成人胫骨髁间棘骨折修复固定22例，其中男12例，女10例；新鲜骨折18例，陈旧性骨折4例；按Meyers—McKeever骨折分型：Ⅱ型8例，Ⅲ型14例。22例骨折全部在关节镜下应用钢丝缝合固定。术后进行系统化的患肢康复训练，包括主动和被动伸屈关节（ROM），髌骨推移锻炼，进行股四头肌、胭绳肌、小腿肌的肌力锻炼，以及患膝的本体感觉训练。结果术后6个月对所有患者均进行随访和康复指导，并进行放射学和，临床评估。放射学检查：术后8周，所有患者的骨折均获得骨性愈合；术后6个月所有患者患膝活动范围均达到了健侧水平，无疼痛症状；4例患者患膝关节有轻微的慢性肿胀。HSS膝关节临床功能评分：优18例，良4例。结论关节镜下钢丝缝合固定治疗胫骨髁间棘骨折具有手术创伤小、操作简便、固定可靠、术后康复快、并发症少等优点，同时可以发现并治疗关节内合并伤，能够最大程度恢复膝关节功能。

Arthroscopically assisted treatment of tibial eminence fracture in adults report of 22 cases

Objective To evaluate the role of arthroscopically assisted treatment of tibial eminence fractures in adults fixed with wire suture. Methods From January 2006 to May 2008,22 consecution patients with adult tibial eminence fractures were treated with wire fixation. There were 18 fresh fractures and 4 old ones;12 males and 10 females. According to Meyers - McKeeve classification systems, there were 8 cases of type Ⅱ and 14 cases of type Ⅲ. Patients started postoperative rehabilitation complied with systematic protocol, included passive and active range of motion （ROM） , patellar movement, quadriceps, hamstring and calf strength training, and proprioceptive training of the injured knee. Results All patients were followed up and assessed in 6 months. Radiologically, all cases showed a completely union after 8 weeks. Clinically, all cases showed full range of motion without pain. Four cases showed mild chronic swelling. The outcome in all patients was graded as excellent, good, fair, and poor according to the hospital for special surgery （HSS） knee score. There were 18 excellent cases,4 good cases,none of fair and poor cases. No knee laxity ,or instability was detected in all the cases, and the affected knees regained full range of motion. The Laehman test and anterior drawer test （ADT） were negative. Conclusions Arthrosopically assisted treatment of tibial eminence fracture can avoid arthrotomy of knee joint, help in diagnosis of other associated intra - articular injuries. It is easy and minimally invasive. It can lead to reliable reduction and fixation, and facilitate early rehabilitation. It may also give a better final outcome when compared with conventional arthrotomy.