前交叉韧带胫骨棘止点撕脱骨折不同内固定疗效分析

[目的]明确前交叉韧带胫骨棘止点撕脱骨折不同内固定对膝关节稳定性和运动功能的影响。[方法]对45例前交叉韧带胫骨棘止点撕脱骨折患者分别进行关节镜下钢丝、丝线、螺钉复位内固定,术后定期随访,按Ly-sholm膝关节功能评分和IKDC膝关节功能评分对术后膝关节功能进行评估,判断患肢整体功能恢复情况。[结果]关节镜下复位内固定取得了较好的膝关节稳定性和运动功能,膝关节活动范围正常,关节功能良好;关节镜复位内固定术后6个月Lysholm膝关节功能评分为(92.2±2.4)分,术后1 a Lysholm膝关节功能评分(95.1±2.7)分;钢丝组、丝线组、螺钉组等内固定之间的Lysholm膝关节功能评分无显著性差异(P>0.05)。[结论]关节镜下钢丝、丝线、螺钉复位内固定是前交叉韧带胫骨棘止点撕脱骨折的重要治疗手段,术后可获得良好的膝关节功能和稳定性。     

A novel arthroscopic procedure for fixation of avulsion fracture of tibial attachment of anterior cruciate ligament guided by meniscal stitching needle

Objective： To introduce a novel technique in which meniscal stitching needle is used as a puller to induct steel wire to secure the tibial eminence avulsion under arthroscopic visualization, and evaluate the cfinical results.
Methods： From 1999 to 2005, fifteen cases of tibial eminence avulsion were treated with this new technique. Lysholm scoring scale system was used to assess knee function before and after surgery. Regular plain anteroposterior and lateral X-ray flms were undertaken to detect the bony healing of avulsed fragment.
Results： The operating time could be controlled within 30 minutes. No complications such as intraarticular infection, iatrogenic injury, fibroarthritis or nonunion of fracture occurred in this group. X-ray film revealed that bony healing in all 15 cases was achieved from 6 weeks to 12 weeks postoperatively. Lysholm score was improved from 19.1 ± 15.2 （ ranging from 10 to 56 ） preoperatively to 97.5 ± 3.7 （ranging from 91 to 100） postoperatively on average in 12-54 months follow up （mean 23 months）. The statistically significant difference was shown in Student＇s t test （t = 18. 483, P =3. 100×10^-11, P 〈 0. 01）. Wire breakage was found in two patients whose wires were removed 8 months and 14 months after initial operation, respectively.
Conclusion： This technique has many advantages, such as simplicity, wide indications from type Ⅱ to type Ⅳ fractures, minimal invasion, short operating time and predictable satisfactory results.     

Arthroscopic physeal sparing all inside repair of the tibial avulsion fracture in the anterior cruciate ligament: technical note

We describe a new and effective arthroscopic physeal sparing repair of the tibial eminence avulsion fracture using all an inside repair technique. The treatment of ACL avulsion is controversial, especially in skeletally immature patients, with concerns about physeal damage, and a more reliable way of fixation is still being pursued for small or comminuted fragments. Screw fixation and suture cerclage has some limitations, especially in the small fragment or skeletally immature patients. We fixed avulsion fragment using all inside repair between the distal portion of the ACL and transverse ligament and periosteum. A crescent suture hook loaded with NO. 0 PDS is introduced and the suture hook pierces the transverse intermeniscal ligament and periosteum. The half length of the PDS is now advanced out through the hook and the end is brought out to the anterolateral portal. With the suture hook located intra-articularly and loaded with half the length of the original PDS, the suture hook repierces the transverse intermeniscal ligament at 5 mm on the side and the remaining half length of PDS is now advanced out through the hook and the end is brought out to the anterolateral portal. After that procedure, the suture hook loaded with NO. 0 absorbable Maxon is introduced through the anteromedial portal for the role of shuttle relay. The suture hook pierces the ACL just above the superior border of the avulsion fragment, the Maxon is now advanced out through the hook and the end is brought out to the anterolateral portal. Subsequently, the suture hook is removed and a suture retriever is introduced through the anterolateral portal. PDS and Maxon are held together and retrieved out of the anterolateral portal by the suture retriever at the same time. Our technique has advantages in small comminuted fractures and skeletally immature patients.     

前交叉韧带胫骨止点撕脱骨折的关节镜治疗

目的：探索前交叉韧带胫骨止点撕脱骨折错位在关节镜下复位及钢丝内固定的新途径。方法：关节镜下骨折块复位及钢丝内固定前交叉韧带胫骨止点撕脱骨折14例。结果：术后14例骨折块位置满意。所有病例均获正常活动范围。结论：本术式为治疗前交叉韧带胫骨止点撕脱骨折错位提供了一种新的术式。关节镜下治疗前交叉韧带胫骨止点撕脱骨折是简便易行和便于推广应用的治疗。     

前交叉韧带胫骨棘止点撕脱骨折的现状与思考

随着关节镜的大量应用,人们对前交叉韧带(ACL)胫骨棘止点撕脱骨折治疗有了更新的认识,国内外对该类骨折从损伤机制、治疗方法、术前术后功能评估、预后等多个方面开展了相关研究工作。但目前临床上对于非手术治疗和内固定方法的应用仍存在着很大的盲目性,单纯凭经验的手法整复、不同内固定方式对骨折的治疗及预后的影响等方面仍然存在较多问题。本文对此进展情况进行了综述,并对其中存在的问题加以分析归纳,提出了有关见解。     

半月板缝合针引导钢丝关节镜下内固定治疗前交叉韧带胫骨嵴撕脱骨折

目的 探讨关节镜下半月板缝合针引导钢丝内固定治疗前交叉韧带（anterior cruciate ligament,ACL）胫骨嵴撕脱骨折的疗效。方法 1999年12月～2005年8月关节镜下应用半月板缝合针引导钢丝内固定治疗ACL胫骨嵴撕脱骨折15例。采用膝关节Lysholm评分对关节镜手术前、后关节功能进行评价,术后定期复查膝关节正侧位X线片。结果 手术操作均在30min以内完成,无关节感染、意外损伤、关节粘连、骨折不愈合并发症发生。15例随访6～54个月,（20.9±15.0）月,复查X线片显示15例骨折愈合良好。术前Lysholm评分10～56分,（19.1±15.2）分,手术后提高至91～100分,（97.5±3.7）分（t=18.483,P=0.000）。2例术后8、14个月出现内固定钢丝断裂,但骨折愈合良好。结论 关节镜下半月板缝合针引导钢丝固定治疗ACL胫骨嵴撕脱骨折,方法简便、适用范围广、创伤小、术后功能恢复满意。     

关节镜下8字缝线与网兜缝线固定治疗前十字韧带胫骨止点撕脱骨折

目的探讨关节镜下8字缝线与网兜缝线固定治疗前十字韧带(anterior cruciate ligament,ACL)胫骨止点撕脱骨折的早期临床疗效。方法回顾性分析2013年8月至2016年11月收治的37例ACL胫骨止点撕脱骨折并获得完整随访的患者,所有患者骨骺均已闭合。Meyers-McKeever-Zaricznyj骨折分型:Ⅱ型10例,Ⅲ型22例,Ⅳ型5例。固定方式采用8字缝线法25例,男17例,女8例,年龄(18.91±9.34)岁(范围14~36岁),以两根2号高强度缝线交叉成8字经胫骨骨道拉出固定骨折块;采用网兜缝线固定12例,男8例,女4例,年龄(19.63±7.85)岁(范围15~33岁),以三根2号高强度缝线编织成网兜经胫骨骨道拉出固定骨折块。手术前后采用Lysholm及国际膝关节评分委员会(International Knee Documentation Committee,IKDC)评分评价膝关节功能,通过Lachman试验及Pivot-shift试验评价膝关节稳定性,并记录手术时间、膝关节活动度及伸膝阻滞情况。结果8字缝线组随访(16.35±5.27)个月(范围10~22个月),网兜缝线组(14.06±7.18)个月(范围10~21个月)。末次随访时,8字缝线组的Lysholm、IKDC评分分别为(95.86±5.74)分、(90.53±4.61)分,网兜缝线组分别为(96.53±3.17)分、(92.15±5.54)分,两组差异无统计学意义(t=0.723,P=0.462;t=1.018,P=0.279);8字缝线组Lachman试验及Pivot-shift试验阴性率均为92%(23/25),网兜缝线组均为100%(12/12),两组差异无统计学意义(χ^2=0.904,P=0.265);网兜缝线组手术时间为(61.8±6.3)min,较8字缝线组的(43.5±5.9)min长,差异有统计学意义(t=2.714,P=0.025);8字缝线组伸膝受限(5°或以上伸膝受限)发生率为16%(4/25),网兜缝线组为0,两组差异有统计学意义(χ^2=0.450,P=0.032)。结论关节镜下8字缝线固定与网兜缝线固定技术治疗ACL胫骨止点撕脱骨折均可获得良好的早期膝关节功能和稳定性。网兜缝线固定技术可完整复位骨折块,术后伸膝阻滞发生率低,在治疗旋转Ⅲ型和粉碎Ⅳ型骨折中可能更具有优势;但有技术要求高、手术时间长的缺点。     

关节镜下缝线8固定成人前交叉韧带胫骨止点骨折的疗效分析

目的探讨关节镜下缝线8字固定成人前交叉韧带（ACL）胫骨止点骨折的手术技术及疗效,为临床治疗提供参考。方法对2008年1月至2013年1月关节镜下采用缝线8字固定成人ACL胫骨止点骨折的33例患者进行回顾性分析,术后随访12-24个月（平均19个月）,对其进行临床评价,包括前抽屉试验、Lachman试验、轴移试验评价膝关节稳定性,Lysholm评分评价膝关节功能,术后X线片评价骨折复位愈合情况。结果术后X线片示骨折均为解剖复位或近解剖复位。患者切口均Ⅰ期愈合。患者前抽屉试验、Lachman试验及轴移试验均呈阴性。Lysholm评分由术前的（43.4±7.8）分,提高至末次随访时的（92.2±7.1）分,比较差异有统计学意义（t=22.3,P〈0.05）。结论关节镜下缝线8字固定成人ACL胫骨止点骨折具有操作简便易行,创伤小,复位佳,固定牢靠,康复快,功能恢复良好,同时避免二次手术,临床疗效满意。     

关节镜下两种方法治疗胫骨髁间嵴骨折的疗效对比

目的比较关节镜下缝线套扎方法和可吸收带线锚钉方法治疗前交叉韧带胫骨止点撕脱骨折的临床疗效。 方法选取2012年6月至2018年2月解放军总医院第一医学中心骨科收治的62例损伤3周以内、伤前患肢功能正常的前交叉韧带胫骨止点撕脱骨折患者为研究对象,同时排除伴有开放性骨折、多发骨折或胫骨平台、半月板及韧带损伤的患者。根据手术方法不同将其分为两组,其中关节镜下应用缝线套扎方法治疗30例患者,关节镜下应用可吸收锚钉方法治疗32例患者。比较两组患者的手术时间、术中出血量;通过前抽屉试验、Lachman试验(屈膝30°前抽屉试验)、轴移试验检查比较两组患者膝关节稳定性;通过Lysholm评分、国际膝关节文献委员会(IKDC)2000膝关节功能主观评分比较两组患者膝关节功能情况。计量资料组间比较采用独立样本t检验,组内比较采用配对t检验,计数资料组间比较采用卡方检验。 结果两组患者手术切口均一期愈合,术后3个月X线检查示髁间嵴撕脱骨折均愈合。缝线套扎组随访13～42个月,平均(22±8)个月;可吸收锚钉组随访12～39个月,平均(19±7)个月。可吸收锚组手术时间低于缝线套扎组,差异有统计学意义(t＝2.491,P <0.05),两组术中出血量差异无统计学意义(t＝1.506,P>0.05)。两组患者术后6个月Lysholm评分较术前提高,差异有统计学意义(缝线套扎组：t＝26.265,P<0.05;可吸收锚钉组：t＝29.857,P<0.05),两组患者术后IKDC 2000膝关节功能主观评分较术前提高,差异有统计学意义(缝线套扎组：t＝35.619,P <0.05;可吸收锚钉组：t＝37.004,P<0.05),术后6个月两组患者膝关节前抽屉试验、Lachman试验、轴移试验及Lysholm评分、IKDC 2000评分差别无统计学意义(P>0.05)。 结论关节镜下缝线套扎方法与可吸收锚钉方法治疗胫骨髁间嵴撕脱性骨折各有其特点,但临床治疗效果相同,均能够实现骨折块有效复位、牢固固定以及骨折愈合,有效恢复患肢功能,获得良好疗效。     

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.     

前交叉韧带胫骨附丽处撕脱骨折髌下微创治疗

目的:介绍一种对前交叉韧带(ACL)胫骨附丽处撕脱骨折的微创治疗途径。方法:ACL胫骨附丽处撕脱骨折患者81例,男64例,女17例;年龄10～58岁,平均37.8岁;交通伤57例,坠落伤15例,运动伤6例,其他伤3例。按Zaricznyj分类:Ⅰ型3例,Ⅱ型16例,ⅢA型21例,ⅢB型25例,Ⅳ型16例。利用经髌下纵切口插入膝关节腔内的食指导引,予ACL胫骨附丽处撕脱骨折复位后,经皮空心钉内固定;骨折块小、Ⅳ型骨折或骨骺未闭合时,钢丝固定。结果:对81例患者进行6～24个月随访,平均18个月,术后3个月膝关节活动度与健侧相比无明显区别,骨折全部愈合,Lysholm膝关节功能评分为(91.6±3.2);术后6个月评分为(95.7±3.6)。结论:ACL胫骨附丽处撕脱骨折髌下微创治疗,操作简便、微创,效果可靠。     

Arthroscopic reduction and fixation of avulsion fracture of the tibial attachment of the anterior cruciate ligament

In treating avulsion fracture of the tibial attachment of the anterior cruciate ligament, surgical reduction and fixation of fractured bone is necessary for patients who have a wide displacement of bone fragment (i.e., types III and IV in the Meyers classification). Our arthroscopic technique allows the creation of bone tunnels on the medial and lateral sides of the bone fragment from the medial side of the tibial tubercle without using special equipment. At surgery, fixation wire is prepared into a loop, pulled into the joint space, and the loop is opened within the joint. This makes intra-articular manipulation easy, and the bone can be reduced more accurately. This arthroscopic technique decreases surgical invasion of the joint, allows good postoperative range of motion without problems, and is useful in preventing extension limitation due to dislocation of the anterior portion of the fragment.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 17, No 9 (November-December), 2001: pp 1003–1006     

Arthroscopic anterior cruciate ligament repair: preliminary results and instrumented testing for anterior stability

The authors present their preliminary results of arthroscopic primary repair of anterior cruciate ligament tears performed on five patients, with a mean follow-up time of 9.2 months. All patients were re-evaluated by subjective questionnaire and clinical examination, and tested for anterior drawer at 20 degrees flexion using the KT-1000 Knee Ligament Arthrometer and the UCLA Instrumented Clinical Knee Testing Apparatus. Subjectively, four patients were rated as fair and one as good. The Lachman test was negative in two and trace or mildly positive in three patients. Pivot shift test was negative in all. Instrumented testing demonstrated three patients with increased anterior laxities outside the normal range, and two of these patients also showed reduced anterior stiffnesses which were beyond the normal range. Based on these results, the authors question the feasibility of arthroscopic repair of anterior cruciate ligament tears and suggest a more objective evaluation of this procedure.     

关节镜单隧道悬吊固定治疗前交叉韧带胫骨止点撕脱骨折

目的探讨关节镜下单隧道悬吊固定治疗前交叉韧带胫骨止点撕脱骨折的方法和临床疗效。 方法回顾性分析2015年3月至2018年1月间27例膝关节前交叉韧带胫骨止点撕脱骨折患者,男19例,女8例,年龄平均(28±8)岁,排除骨质疏松、病理性骨折等。骨折按Meyers-Mckeever分型,Ⅱ型9例,Ⅲ型14例,Ⅳ型4例。本组患者均采用关节镜下单隧道缝线环绕固定方法治疗。定期复查X片观察骨折愈合情况,Lysholm评分系统评价膝关节功能,疼痛采用视觉模拟法(VAS)进行评定;主观因素包括肿胀、关节稳定性及参加工作满意度;记录并发症。术前术后评分比较采用配对样本t检验。 结果术后随访平均(18±6)个月。骨折均在3个月内愈合,无感染、内固定松动等并发症。27例患者膝关节功能恢复正常,26例患者末次随访Lachman试验及前抽屉试验均阴性,1例患者随访体检时膝关节Ⅱ°松弛,自诉无腿软不稳现象。视觉模拟VAS评分平均为(1.0±0.6)分。术前膝关节Lysholm评分(42±9),末次随访膝关节Lysholm评分(90±6),差异有统计学意义(t ＝22.365,P <0.01)。主观评价所有患者日常生活无明显影响。 结论关节镜下单隧道悬吊固定缝线技术治疗前交叉韧带止点撕脱骨折,手术操作创伤小,简单方便,骨折复位固定牢靠,术后功能恢复快,是一种较理想的手术方法。     

Meniscus repair with simultaneous anterior cruciate ligament reconstruction: Clinical outcomes,failure rates and subsequent processing

PurposeTo retrospectively analyze the clinical outcomes of meniscus repair with simultaneous anterior cruciate ligament (ACL) reconstruction and explore the causes of failure of meniscus repair.MethodsFrom May 2013 to July 2018, the clinical data of 165 patients who were treated with meniscus surgery and simultaneous ACL reconstruction, including 69 cases of meniscus repair (repair group) and 96 cases of partial meniscectomy (partial meniscectomy group) were retrospectively analyzed. The exclusion criteria were as follows: (1) ACL rupture associated with fracture, collateral ligament injury, or complex ligament injury; (2) a history of knee surgery; or (3) a significant degree of osteoarthritis. The 69 patients in the repair group were divided into the non-failure group (62 cases) and the failure group (7 cases) depending on the repair effect. Postoperative outcomes of the repair group and the partial meniscectomy group were compared. General conditions and postoperative outcomes of the failure group and the non-failure group were compared. During the median follow-up period of 28 months (range, 4 - 65 months) after the second arthroscopy, postoperative outcomes of seven patients in the failure group were summarized. SPSS 25.0 statistical software was used for statistical analysis. A p value less than 0.05 was considered statistically significant.ResultsSeven patients in the failure group who underwent the second arthroscopy were followed up for (30 ± 17.4) months and their postoperative outcomes were summarized. Compared with the partial meniscectomy group, the International Knee Documentation Committee scores of patients in the repair group improved significantly (p = 0.031). Compared with the non-failure group, more patients in the failure group were younger than 24 years (p = 0.030). The median follow-up period was 39.5 months. All patients recovered well after subsequent partial meniscectomy and relieved clinical symptoms. Visual analog scale scores decreased significantly (p = 0.026), and the International Knee Documentation Committee and Lysholm scores improved significantly (p = 0.046 for both).ConclusionThe failure rate of meniscus repair in this study was 10.1% (7/69), all of which were medial meniscus tears. However, the surgical outcomes of ACL reconstruction were not affected, and there might be a role for graft protection. Therefore, meniscus retears can be successful treated by performing subsequent partial meniscectomy in patients with repair failure.     

不同时机膝关节镜下前交叉韧带重建术的临床研究

目的:分析不同时机行膝关节镜下前交叉韧带重建术治疗前交叉韧带损伤的效果.方法:选取2017～2019年收治的102例前交叉韧带损伤患者,根据受伤至手术时间进行分组,其中≤3周为早期组(n=52),>3周为晚期组(n=50),对比两组手术效果.结果:两组术后Lysholm评分、国际膝关节文献委员会膝关节评估表评分、膝关节...     

计算机导航关节镜下前十字韧带重建术

目的介绍计算机导航技术辅助关节镜下前十字韧带重建术的术前规划和手术方法,比较导航技术辅助与单纯关节镜技术中股骨、胫骨隧道位置的优良率。方法根据术前标准正侧位X线片设计股骨、胫骨隧道的理想位置。术中“C”型臂X线机获得正侧位影像后输入计算机,形成虚拟工作界面。膝关节周围分别于股骨、胫骨侧安置“患者追踪器”。前十字韧带胫骨及股骨导向器上分别装配“工具追踪器”。经过注册及校准后,导航系统识别并捕获上述追踪器发射的信号,确定膝关节的位置,实时跟踪手术工具的位置和方向,并将隧道的虚拟路径叠加在工作界面上,供术者实时调整导向器的位置与方向,直至达到术前规划的要求。临床上完成计算机导航关节镜下前十字韧带重建术46例。对其中40例进行术后X线片测量,确定胫骨及股骨隧道的位置,并与同期进行的40例单纯关节镜下重建术隧道位置的测量结果进行比较。结果导航组胫骨隧道位置平均为45.35%±3.827%(37%￣53%),股骨隧道位置平均为62.25%±5.610%(52%￣73%);关节镜组胫骨隧道位置平均为41.05%±6.008%(25%～54%),股骨隧道位置平均为56.62%±7.316%(46%￣77%)。导航组的股骨及胫骨隧道位置较关节镜组偏后,差异有统计学意义(P<0.05),导航组的标准差小于关节镜组。结论计算机导航技术可以使关节镜下前十字韧带重建手术中胫骨及股骨隧道的位置更偏后,提高了手术准确性及可重复性。     

关节镜下全内技术股骨双隧道重建膝关节前交叉韧带

目的总结关节镜下利用全内技术股骨双隧道重建膝关节前交叉韧带的临床疗效。 方法收集于2015年12月至2016年8月期间在上海同济大学附属第十人民医院骨科住院治疗的膝关节前交叉韧带断裂病例,根据纳入、排除标准,共有16例(16膝)纳入本研究,男性11例(68.8%),女性5例(31.3%),平均年龄(30 ± 6)岁。回顾性分析手术前及末次随访时国际膝关节文献委员会(IKDC)膝关节评分及分级、Lysholm评分、KT2000值、Lachman试验情况、轴移试验情况。采用SPSS 13.0统计学软件对IKDC评分、Lysholm评分、KT2000值行配对样本t检验,Lachman试验情况、轴移试验情况等计数资料行秩和检验或卡方检验。 结果16例患者随访时间14～32个月,平均25.5个月(22.3,29.6)个月。随访期内未出现移植物断裂、TightRope?钢板固定失效、血栓性静脉炎、关节感染、隐神经损伤。IKDC评分、Lysholm评分分别由术前的(67±4)分、(63±6)分提高至末次随访时(95±5)分、(95±4)分,差异具有统计学意义(t＝－19.40、16.04,均为P<0.01)。IKDC分级术前A级0例,B级1例,C级1例,D级14例;术后A级13例、B级3例、C级0例、D级0例(Z＝－5.18,P<0.05),差异具有统计学意义。KT2000值术前平均(5.8±1.3)mm,优于术后测得平均(1.2±0.6)mm,差异有统计学意义(t＝12.24,P<0.01);Lachman试验术前阳性15例、阴性1例,术后阳性0例、阴性16例;轴移试验术前阳性13例、阴性3例,术后阳性0例、阴性16例。 结论利用全内技术行关节镜下股骨双隧道膝关节前交叉韧带重建,患者膝关节功能、前直向不稳定、前外侧旋转不稳定的近期疗效满意。     

前交叉韧带早期重建术后股骨外侧髁压迹远期转归的相关研究

目的:探讨前交叉韧带(anterior cruciate ligament,ACL)早期重建术后股骨外侧髁压迹(lateral femoral notch,LFN)的转归并评估术后膝关节功能恢复情况。方法:对2015年12月至2019年12月间接受早期前交叉韧带重建的32例的临床资料进行回顾性分析,其中男18例,女14例,年龄16～54(25.39±2.82)岁;身体质量指数(body mass index,BMI)为20～30(26.15±3.09) kg/m²;交通伤6例,运动损伤19例,重物压伤7例。膝关节MRI显示所有患者损伤后LFN深度>1.5 mm,且术中对于LFN未进行干预。通过MRI资料观察患者手术前后的LFN缺损深度、面积及体积,对患者手术前后的国际软骨修复学会(International Cartilage Repair Society,ICRS)评分、Lysholm评分、Tegner活动水平、膝关节损伤和骨关节炎结局评分(knee injury and osteoarthritis outcome score,KOOS)进行分析。结果:...     

计算机导航辅助关节镜下重建前交叉韧带

目的通过与传统关节镜下重建前交叉韧带(ACL)手术进行比较,说明基于X线影像的计算机导航系统辅助关节镜下重建ACL的手术方法隧道定位更精确。方法2005年12月-2006年3月共完成40例计算机导航系统辅助关节镜下ACL重建手术。选择2005年6月-2006年3月40例传统关节镜下ACL重建手术作为对照组,在X线片上分别测量胫骨隧道和股骨隧道的位置,对两组患者测量结果进行统计学分析。结果计算机导航系统辅助关节镜下ACL重建手术组测量股骨隧道位置平均值为62．3％±5．6％(52％-73％),传统手术组测量股骨隧道位置平均值为56．6％±7．3％(46％-77％)。胫骨隧道位置测量,导航辅助手术组平均值为45．4％±3．8％(37％-53％),传统手术组平均值为41．1％±6．0％(25％-54％)。两组患者的股骨隧道和胫骨隧道位置分别做统计学分析,差异均有显著性意义(P< 0．05)。导航辅助手术组数据更接近解剖重建ACL位置。计算机导航系统辅助关节镜下ACL重建的平均手术时间较传统手术延长20 min,透视次数为4次。结论基于X线影像的计算机导航系统辅助关节镜下ACL重建手术是安全、可行的,可以使股骨、胫骨隧道位置更精确。