关节镜下治疗前交叉韧带胫骨止点撕脱性骨折

目的 探讨在关节镜辅助下对Ⅱ、Ⅲ型胫骨止点骨折进行微创治疗的手术方法及近期疗效。方法 自2001年5月至2006年6月，共手术治疗27例前交叉韧带胫骨止点撕脱性骨折，其中合并半月板损伤11例。术中在关节镜辅助下，首先处理合并损伤，然后通过关节镜观察应用探钩等对骨折进行复位，通过克氏针临时固定，“C”臂机透视确认后，再根据骨折移位和骨片大小选择空心钉螺钉或钢丝等固定。21例应用AO松质骨螺钉固定，5例采用钢丝固定，1例用可吸收线缝合固定；术后按程序进行康复锻炼。结果 27例患者均获得随访，平均随访时间（12±5）个月，术后无切口愈合不良、感染和骨筋膜间室综合征等早期并发症，骨折在3～4个月骨性愈合，23例膝关节功能完全正常，4例活动范围0°～100°，根据Rasmussen评分，26例病例为优良，1例为可，本组总评分为27±1。结论 在治疗胫骨止点Ⅱ、Ⅲ型骨折时，采用关节镜辅助下撬拨复位空心钉、钢丝等固定的手术，具有创伤小、可同时处理关节腔内的其他损伤等优势，可以获得骨折愈合快、膝关节功能良好的近期疗效，因此值得推广应用。

Arthroscopic treatment of the tibia intercondylar eminence fractures

Objective To introduce a minimal surgical treatment of tibial intercondylar eminence fractures under arthroscopc and its corresponding therapeutic effect. Methods From May 2001 to June 2006,27 patients with tibial intercondylar eminence fractures were treated by arthroscopic fixation and 11 patients had associated meniscal injury. The combined injuries were treated firstly. Then, the dissociative fragments were reduced and fixed. The internal fixation was observed by C-arm X-ray equipment. 21 cases were treated with AO cancellous bone screw,5 cases with steel wiring internal fixation and one with absorbable suture. Postoperative management was carried out step by step according to a routine treatment protocol. Results All patients were followed up for 12 ± 5 months. The fractures were healed in 3-4 months. No case had severe complication, such as osteofascial compartment syndrome, infection, deformity ,joint stiffness and so on. 23 patients exhibited normal activity. The range of flexion and extension of the knee joint were 0-100 degrees. According to the Rasmussen scoring system ,26 cases were excellent or good results and one common ,the mean score was 27 ± 1. Conclusion Arthroscopic reduction and percutaneous fixation for the treatment of type Ⅱ , Ⅲ tibial intercondylar eminence fractures is characterized by minimal invasion, fast fracture healing and sound knee joint function. And all the combined injuries can be treated at the same time. So it is worth further clinical application.