关节镜下胫骨髁间隆突骨折张力带钢丝固定

髁间隆突骨折在膝关节损伤中非常多见,由于前交叉韧带的牵拉,骨折块往往移位明显,欲达到解剖复位,可在关节镜下复位内固定。大多数学者认为,伴有撕脱骨折块的韧带损伤,应一期复位固定。自2000～2002年在关节镜下张力带钢丝固定治疗髁间隆突骨折取得良好结果。报告如下。     

关节镜下治疗急性胫骨髁间隆突撕脱骨折

胫骨髁问隆突前部是前交叉韧带（ACL）的胫骨附着点，在ACL的强力牵拉下可导致撕脱骨折，形成膝关节前向不稳定，并可引起股骨髁问窝撞击征。既往的治疗方法一般采用经膝关节切开复位内固定术，这不可避免造成关节的较大创伤并可引起关节疼痛、僵硬及活动受限。在关节镜下进行胫骨髁间隆突撕脱骨折的治疗，创伤小、骨折固定可靠、术后恢复快，是目前该骨折理想的治疗方法。1999年10月-2004年6月经关节镜治疗胫骨髁问隆突撕脱骨折23例，获得了良好的疗效。     

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。     

胫骨髁间隆突骨折14例治疗体会

胫骨髁间隆突是膝关节前交叉韧带的附丽点,包括胫前髁间棘及其前外侧的三角形低平部。此处无关节软骨复盖,表面有一薄层皮质骨,深部为松质骨。一般认为儿童膝关节损伤时易发生胫骨隆突撕脱骨折,而成人则易发生前交叉韧带实质部断裂。我们自1977年5月至1987年12月共收治胫骨髁间隆突骨折14例,均行开放复位,单或多根钢丝内固定,取得满意效果,现报告如下。     

胫骨髁间嵴骨折的治疗进展

胫骨髁间嵴撕脱骨折是一种较少见的关节内骨折.胫骨髁间嵴是膝关节前交叉韧带的附着点.当胫骨髁间嵴撕脱骨折后,将导致膝关节明显不稳.目前对其治疗方法上存在不同意见,主要有闭合复位、切开复位加内固定、关节镜下复位内固定等几种治疗方法.     

有限切开钢丝固定治疗胫骨髁间棘撕脱骨折38例

目的 探讨有限切开钢丝固定治疗胫骨髁间棘撕脱骨折。方法 采用膝关节有限切开，直视下复位后，钢丝固定治疗胫骨髁间棘撕脱骨折38例。结果 38例全部获得随访，关节活动恢复良好，无膝部疼痛和不稳。结论 有限切开、可抽出钢丝固定是治疗胫骨髁间棘撕脱骨折的有效方法。     

胫骨后髁间撕脱骨折手术治疗9例报告

我院自1989年以来共收治9例后交叉韧带胫骨后髁间附着处撕脱骨折病例,均采用切开复位,钢丝内固定术,效果优良,报告如下。 1 临床资料 1.1 一般资料 9例均为男性,年龄19～46岁。右侧4例,左侧5例;3例伤后即确诊,4例为院外误诊,2例住本院因患者受伤当时颅脑损伤较重,膝部损伤漏诊,伤后1个月由专科医生确诊。所有患侧膝关节X线片均不同程度显示关节间隙后侧有一游离骨片,胫骨髁间后部有骨缺损区。 1.2 手术方法 膝关节后正中切口,显露并纵形切开后关节囊,即可显露后交叉韧带胫骨附着部的撕脱骨折面,于后关节间隙内找到带有骨折块的后交叉韧带,清理骨折断面,经胫骨骨折缺损区边缘水平钻2孔达胫骨内髁前方出孔,用φ0.8mm钢丝穿过撕脱骨折块的后交叉韧带附着部,钢丝两头分别从胫骨前方     

有限切开钢丝固定治疗胫骨髁间棘撕脱骨折38例

目的　探讨有限切开钢丝固定治疗胫骨髁间棘撕脱骨折。方法　采用膝关节有限切开 ,直视下复位后 ,钢丝固定治疗胫骨髁间棘撕脱骨折 38例。结果　 38例全部获得随访 ,关节活动恢复良好 ,无膝部疼痛和不稳。结论　有限切开、可抽出钢丝固定是治疗胫骨髁间棘撕脱骨折的有效方法     

钢丝、丝线、肌腱引导器研制与应用

遇到髌骨部分骨折,胫骨髁间隆突撕脱骨折,膝关节交叉韧带断裂后重建,部分骨折块复位后固定需要在骨折复位后或韧带固定时用钻孔穿钢丝或丝线肌腱固定,因钢丝、丝线、肌腱柔软,经过骨孔或用其它引导物时常不便,我们采用自制的骨孔引导器,经临床应用效果满意。 1 结构与制作 (1)针套用100mm×1.6mm或100mm×1.8mm金属穿刺针外套。(2)针芯为双根,针芯前端连接呈圈套形,采用长200mm,直径0.4mm不锈钢丝。     

关节镜下多点张力克氏针固定治疗胫骨髁间嵴撕脱骨折

[目的]研究一种膝关节镜下治疗前交叉韧带胫骨止点撕脱骨折的手术方法,并研发专用工具以提高临床疗效。[方法]选择36例前交叉韧带胫骨止点撕脱骨折患者,按Meyer-Mc Keever-Zaricznyj分型:Ⅰ型2例,Ⅱ型10例,Ⅲa型16例,Ⅲb型5例,Ⅳ型3例。在膝关节镜下通过自主研发专用胫骨髁间嵴骨折复位器、胫骨髁间嵴骨折固定导向器用多根克氏针穿过前交叉韧带胫骨止点撕脱骨折,在胫骨隧道外拉紧克氏针张力下复位固定骨折块。[结果]本组未出现术后感染、切口延迟愈合、血管神经损伤、内固定物松动等并发症。本组32例患者术后获得随访,时间8~30个月。术后8周均获得骨性愈合,术后8周所有患者均完全负重行走。术后前抽屉试验和Lachman试验均为阴性。术后8周Lysholm评分(89.51±1.62)分,随访终末期Lysholm评分(94.30±1.41)分,优10例,良19例,可3例,优良率90.63%。[结论]应用关节镜下张力克氏针多针固定治疗胫骨髁间嵴骨折效果良好,辅以专用关节镜下胫骨髁间嵴骨折复位器、关节镜下胫骨髁间嵴骨折固定导向器可以使治疗更加简洁、高效、安全、可靠。     

Comparison of closed reduction and expert tibial nailing with open reduction and plate and screw fixation in the treatment of two segmental tibial fractures

Purpose: To compare the outcomes of closed reduction and expert tibial nailing (ETN) versus open reduction and plate and screw fixation in treating two segmental tibial fractures. Methods: This study included 53 cases of two segmental fractures of the tibial shaft. They were admitted to our department between March 2010 and June 2013 and treated respectively by closed reduction and ETN (ETN group, n=31) or open reduction fixation with plate and screws (PS group, n=22). The general data of two groups including gender, age, injury cause, fracture type, etc showed no significant difference (p>0.05). To compare the therapeutic effects between two groups, the intraoperative condition, postoperative function and related complications were investigated. Results: All the patients were successfully followed up. The period was 19.2 months for ETN group and 20.5 months for PS group. All the fractures in ETN group had union without complications such as malunion, infection, or osteofascial compartment syndrome; whereas there were 3 cases of superficial infection cured by repeated dressing change and 2 cases of delayed union in PS group. The total incidence of complication in PS group was 22.7% (5/22), much higher than that in ETN group (p<0.05). Moreover, ETN group showed a better result in terms of intraoperative blood loss, operation time, postoperative weight bearing time and fracture union time. In ETN group, at one-year follow-up, Johner-Wruhs'' criteria was adopted to assess the postoperative function, which was reported as excellent in 18 cases, good in 10 cases and fair in 3 cases in ETN group (100% excellent-good rate). While in PS group, the result was excellent in 10 cases, good in 7 cases, fair in 3 cases and poor in 2 cases (77.3% excellent-good rate). The comparison was insignificant (p>0.05). Conclusion: Compared with plate and screw fixation, ETN fixation has the advantages of fewer complications, shorter operation time, being less invasive, earlier postoperative rehabilitation and weight bearing, quicker fracture union and better functional recovery, thus being an effective way to treat two segmental tibial fractures.     

Treatment of open and closed tibial fractures with unreamed interlocking tibial nails

Surgical Principles Intramedullary splinting of acute open and closed tibial fractures without reaming the medullary canal using load bearers of small calibers with concurrent interlocking of the main bone fragments through which loads are transmitted.     

解剖型胫骨髁钢板治疗胫骨平台骨折

[目的]探讨胫骨平台骨折内固定的方法，评估内固定手术的疗效。[方法]对本科2000～2006年收治的22例胫骨平台骨折手术内固定患者进行随访，并进行回顾性分析，全部患者均采用德国LINK解剖型髁钢板内固定。[结果]本组患者平均随访33．3个月，骨折均于3个月愈合。膝关节功能恢复情况根据关节活动度、疼痛、关节稳定性进行HSS评分，平均89．5分。[结论]解剖型胫骨髁钢板可很好的治疗各型胫骨平台骨折，手术操作简单，治疗效果满意，是治疗胫骨平台骨折的良好的内固定材料。     

Nonunion after a tibial shaft fracture complicating tibial tubercle osteotomy

Tibial shaft fracture after tibial tubercle osteotomy in total knee replacement is a rare complication. We report on a 67-year-old man who had a knee revision arthroplasty in which a long tubercle osteotomy was performed to facilitate exposure. Three weeks after surgery, he presented with a transverse shaft fracture, which became a nonunion requiring surgical management. This shaft nonunion and its solution after tibial tubercle osteotomy is discussed as well as relevant literature.     

胫骨去后倾化截骨在合并后倾角异常增大患者前交叉韧带翻修术中的临床应用北大核心CSCD

目的探讨胫骨去后倾化截骨加前交叉韧带(anterior cruciate ligament,ACL)翻修术治疗ACL初次重建术后失效合并胫骨平台后倾角(posterior tibial slope,PTS)异常增大患者的临床疗效。方法回顾分析2018年1月—2020年1月收治且符合选择标准的9例ACL初次重建术后失效合并PTS异常增大(≥17°)患者的临床资料。男8例,女1例;年龄21~42岁,中位年龄30岁。9例患者Lachman试验均为阳性;轴移试验阴性6例,Ⅰ度阳性2例,Ⅱ度阳性1例。PTS为(17.78±1.09)°、胫骨平台前移距离(anterior tibial translation,ATT)为(11.58±1.47)mm。国际膝关节文献委员会(IKDC)评分为(51.0±3.8)分,Lysholm评分为(49.7±4.6)分、Tegner评分为(3.7±0.7)分。初次重建至翻修时间为12~33个月,平均19.6个月。采用胫骨去后倾化截骨加ACL翻修术治疗。术后采用IKDC评分、Lysholm评分及Tegner评分评价膝关节功能改善情况,行Lachman试验、轴移试验评价膝关节稳定性,测量PTS及ATT观察膝关节形态学变化。结果术后切口均Ⅰ期愈合,未出现切口感染、脂肪液化、坏死以及下肢深静脉血栓形成、神经血管损伤等并发症。9例患者均获随访,随访时间12~36个月,平均25.8个月。末次随访时Lachman试验和轴移试验均为阴性。IKDC评分为(85.0±4.0)分、Lysholm评分为(87.7±2.8)分、Tegner评分为(6.8±0.7)分,PTS减小至(9.89±0.60)°,ATT缩短至(0.91±0.29)mm,与术前比较差异均有统计学意义(P<0.05)。结论胫骨去后倾化截骨加ACL翻修术治疗ACL初次重建术后失效合并PTS异常增大患者早期临床疗效明确,在改善膝关节稳定性同时可较好地维持正常膝关节形态。     

关节镜下治疗胫骨髁间隆起撕脱骨折

1999年7月～2005年7月,我科在关节镜下微创治疗19例胫骨髁间隆起撕脱骨折患者,取得满意的疗效.     

关节镜下治疗胫骨平台塌陷和髁间棘撕脱骨折

目的　探讨应用关节镜技术在微创条件下治疗胫骨平台塌陷和髁间棘撕脱骨折。方法　在关节镜下治疗胫骨平台塌陷 2例 ,髁间棘撕脱骨折 2例 ,胫骨后侧平台塌陷伴髁间棘撕脱骨折 1例。结果　 5例病人骨折复位满意 ,髁间棘撕脱骨折病例其交叉韧带均恢复其张力。患膝无疼痛及不稳 ,关节活动恢复良好。结论　关节镜的使用为治疗胫骨平台塌陷和髁间棘撕脱骨折提供了一种创伤极小、可准确复位手术新方法