关节镜下掌骨钢板结合不可吸收缝线固定治疗前交叉韧带止点撕脱骨折

目的探讨关节镜下掌骨钢板结合不可吸收缝线固定治疗前交叉韧带（ACL）止点撕脱骨折的临床效果。方法对16例有明显移位的ACL止点撕脱骨折在关节镜下进行复位,使用掌骨钢板结合不可吸收Ethieon缝线进行固定。术后进行积极康复训练。结果16例获随访0．5～2．5年,术后所有骨折均获得愈合,无骨折移位出现。术后3个月,无膝关节松弛或者不稳定发生,所有患者膝关节活动度均恢复至伤前水平。末次随访时IKDC主观膝关节功能评分平均（95．1±2．8）分。结论关节镜下利用掌骨钢板和不可吸收缝线固定治疗ACL止点撕脱骨折复位和固定效果好、创伤小,可早期进行膝关节康复训练,能够尽快恢复膝关节功能。     

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。     

小切口锚钉缝线内固定治疗后交叉韧带胫骨止点撕脱骨折

目的探讨小切口锚钉缝线内固定治疗后交叉韧带（PCL）胫骨止点撕脱骨折临床疗效。方法对27例PCL胫骨止点撕脱骨折患者经膝后内侧小切口锚钉缝线内固定。结果患者均获得随访,时间6～24（12.5±4.1）个月。术后6周膝关节活动度为90～132（117.6±6.1）,°6个月为121～148（139.1±5.3）°,较健侧减少2～6（3.1±1.2）°。采用Lyscholm膝关节评分法评估疗效：优25例,良2例。结论小切口锚钉缝线内固定治疗PCL胫骨止点撕脱骨折方法简单,固定可靠,效果良好。     

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。     

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.     

单隧道免打结锚钉治疗后交叉韧带胫骨止点撕脱骨折

目的总结关节镜下利用单隧道免打结锚钉治疗后交叉韧带(PCL)胫骨止点撕脱骨折的效果。 方法回顾性分析2017年1月至2019年4月淮南朝阳医院骨科收治的PCL胫骨止点撕脱骨折患者,按照纳入排除标准,共纳入36名行关节镜单隧道免打结锚钉内固定治疗的患者。比较每例患者术前及术后6个月的膝关节活动度(ROM)、国际膝关节文献委员会(IKDC)膝关节韧带评估表、Lysholm膝关节功能评分及并发症情况,进行配对立样本t检验。 结果术后6个月随访ROM范围(t＝－22.231)、IKDC评分(t＝－34.958)、Lysholm评分(t＝－40.802)均比术前明显改善(均为P<0.05);所有患者均未出现腘窝神经、血管损伤。 结论采用关节镜下单隧道免打结锚钉内固定技术治疗后交叉韧带胫骨止点撕脱骨折,膝关节功能恢复情况满意。     

前交叉韧带胫骨止点撕脱骨折关节镜下骨与周围组织损伤分级及其意义

目的 提出前交叉韧带胫骨止点撕脱骨折关节镜下骨与周围组织损伤分级,分析其与Meyers-McKeever分型的一致性,为术前精准评估及治疗方案选择提供指导.方法 前交叉韧带胫骨骨性止点及足印为D区,以此为中心,前内侧区域包括内侧半月板前部及膝横韧带内侧部为A区;前外侧区域包括外侧半月板前角及膝横韧带外侧部为B区;后方区...     

关节镜下空心螺钉固定治疗后交叉韧带胫骨止点撕脱骨折

目的探讨关节镜下后内侧入路中空螺钉固定治疗后交叉韧带胫骨止点撕脱性骨折的手术技巧及疗效。方法对15例后交叉韧带胫骨止点撕脱性骨折行关节镜下复位经后内侧入路,克氏针临时固定,经克氏针置入单枚带垫片直径4.5 mm中空钛质螺钉固定。结果手术时间40～82 min,平均55 min。随访6～24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窝部神经、血管损伤并发症。所有患者均无屈伸膝活动受限,仅1例患者后抽屉试验弱阳性。术后半年Lysholm膝关节功能评分89～96分,平均92.5分。结论关节镜下通过后内侧入路带垫片中空螺钉治疗后交叉韧带胫骨止点撕脱性骨折,操作方便、安全,效果可靠。     

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.     

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。     

Arthroskopische Wiederherstellung einer Ausrissfraktur des hinteren Kreuzbands am Tibiaansatz

Avulsion fracture of the tibial insertion of the posterior cruciate ligament (PCL) is a rare condition. Until recently, bony avulsion fractures of the PCL have been repaired with open reduction and internal fixation. Posterior approach commonly used for open repair is rather extensive, yet it does not allow for detection and managment of associated intraarticular injuries of the knee. We report a case of avulsion fracture of the tibial attachment of the PCL managed by arthroscopic reduction and fixation. A large bony fragment that extended into the posterior part of the lateral tibial plateau allowed for reduction and retrograde fixation through anterior portals only.     

Displaced anterior cruciate ligament avulsion fractures: Arthroscopic staple fixation

Background:

Anterior cruciate ligament (ACL) avulsion fracture is commonly associated with knee injuries and its management is controversial ranging from conservative treatment to arthroscopic fixation. The aim of our study was to assess the clinical and radiological results of arthroscopic staple fixation in the management of ACL avulsion fractures.

Materials and Methods:

Twenty-two patients (17 males and 5 females) who underwent arthroscopic staple fixation for displaced ACL avulsion fractures were analysed. The mean age was 32.2 years (15-55 years) with a mean followup of 21 months (6-36 months). All patients were assessed clinically by calculating their Lysholm and International Knee Documentation Committee (IKDC) scores and the radiological union was assessed in the followup radiographs.

Results:

The mean Lysholm score was 95.4(83-100) and the mean IKDC score was 91.1(77-100) at the final followup. In 20 patients anterior drawer''s test was negative at the end of final followup while two patients had grade I laxity. Associated knee injuries were found in seven cases. The final outcome was not greatly influenced by the presence of associated injuries when treated simultaneously. At final followup all the patients were able to return to their pre-injury occupation

Conclusion:

Arthroscopic staple fixation is a safe and reliable method for producing clinical and radiological outcome in displaced ACL avulsion fractures.     

Type III tibial avulsion fracture with associated anterior cruciate ligament injury: Report of two cases in adults

Tibial spine avulsion fractures are more common in children than adults. Many reports have provided classification and treatment options, including fixation for displaced type III fractures. However, long-term follow-up on injury to the anterior cruciate ligament and knee joint stability in adults is not well documented. We present 2 cases of type III tibial avulsion fractures in adults with associated interstitial injury to the anterior cruciate ligament. Primary anterior cruciate ligament reconstruction was performed in both patients.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 17, No 5 (May-June), 2001: E20     

Arthroscopic management of avulsion fractures of the tibial attachment of the posterior cruciate ligament: A novel technique and mid-term outcomes

PurposeThis study assessed the outcomes of arthroscopic management of avulsion fractures of the tibial attachment of the posterior cruciate ligament (PCL), with holding of the PCL with two ''cinch knots''.Methods15 patients with avulsion fractures of the tibial attachment of the PCL were treated with arthroscopic reduction and fixation with holding of the PCL with two ''cinch knots''. All patients were males with mean age of 28 (range, 15–44) years. Patients were assessed by the Lysholm Tegner knee scale and IKDC (International knee documentation committee) objective grade.ResultsThe mean follow-up period was 40 (range, 12–60) months. Mean postoperative flexion was 134.7° (range, 120–150). Mean Lysholm score was 90.27 (range, 67–99). Lysholm score was excellent in seven (46.7%) patients, good in six (40%) patients, fair in two (13.3%) patients, and none of the patients was poor. 11 (73.3%) patients had IKDC grade A, and four (26.7%) patients had IKDC grade B due to residual grade 1+ posterior drawer. Current Tegner activity level remained the same in nine (60%) patients, decreased one level in three (20%) patients, and decreased two levels in three (20%) patients as compared to the preinjury level. There wasn't any vascular or nerve complications.ConclusionArthroscopic treatment of PCL tibial avulsion fractures with the cinch knot technique has many advantages, and it proved to be safe and effective. The technique is simple and easy to be reproduced. Early results are promising to encourage surgeons to make this novel technique.Level of evidenceTherapeutic study, prospective case series with no comparison group, Level IV.     

镜下“8”字法缝线固定后交叉韧带胫骨撕脱骨折

[目的]介绍关节镜下“4”字位三入路“8”字缝线固定治疗后交叉韧带(posterior cruciate ligament,PCL)胫骨止点撕脱骨折的手术技术与初步效果。[方法]2019年3月-2021年3月,采用“4”字位三入路“8”字法缝线固定PCL胫骨撕脱性骨折28例。常规建立前外、前内和后内3个人口。从前内侧人口将2根强生Orthocord缝线经PCL前侧绕过后,从后内侧入口将缝线拉出并打结,防止骨块松脱。然后,将缝线两端交叉后,分别导入两个骨道,由胫骨前拉出。再次将PCL胫骨隧道定位器钩端置于骨块上,用其将骨块向后推压,进行临时复位固定。调整固定缝线使其从骨块后上方跨过,对膝施加前抽屉应力,复位固定骨块,同时拉紧缝线两端,使缝线牢固嵌压固定骨折块,将缝线尾端在骨道外口固定到门形钉或Versalok上完成固定。[结果]28例患者均顺利完成手术,无血管、神经损伤等严重并发症。Lysholm评分由术前(33.14±9.60)分显著增加至末次随访时(84.07±5.43)分(P<0.05);IKDC评分由术前(32.39±84.79)分显著增加至末次随访时(84.79±4.42)分(P<0.05)。末次随访时,临床检查显示,28例患者均无膝关节松弛或不稳定,膝活动度与健侧对称。影像方面,28例骨折均达临床骨愈合,无骨折移位。[结论]本技术具有简便易行、固定牢靠的优点,临床疗效满意。     

Displaced avulsion fractures of the posterior cruciate ligament: Treated by stellate steel plate fixation

Background:

The open reduction with internal fixation is an effective approach for treatment of avulsion fracture of posterior cruciate ligament. The previously used internal fixation materials including hollow screws, absorbable screw, tension bands and sutures have great defects such as insufficient fixation strength, susceptibility to re-fracture, etc. Stellate steel plate is novel material for internal fixation which has unique gear-like structure design. We used stellate steel plate for treatment of displaced avulsion fractures of posterior cruciate ligament in this study.

Materials and Methods:

14 patients (9 men, 5 women; aged, 19–35 years; mean age, 28 years) with displaced avulsion fractures of the tibial insertion of the posterior cruciate ligament were retrospectively analyzed between June 2009 and June 2011. The mean duration from injury to the operation was 8.3 days (range 6–15 days). All the patients were treated with open reduction and internal fixation of a stellate steel plate (DePuy, Raynham, MA 02767, USA). The Lysholm-Tegner knee function score criteria were used to analyze results.

Results:

The mean followup was 24.6 months (range 18–32 months). After 6 months, all the fractures healed and knee joint activity was normal, with no knee stiffness or instability. The Lysholm-Tegner scores were 97.1 ± 1.7 points at the final followup.

Conclusion:

Owing to its unique gear structure, the stellate steel plate design can effectively fix an avulsion fracture block and it is a simple operation with short postoperative rehabilitation time and firm fixation.     

The anatomy of tibial eminence fractures: arthroscopic observations following failed closed reduction

BACKGROUND: Failed manipulative reduction of avulsion fractures of the tibial insertion of the anterior cruciate ligament has been attributed to interposition of soft tissues, particularly the anterior horn of the medial meniscus. The objectives of the present report were (1) to show that the failure to reduce Meyers and McKeever type-III tibial eminence fractures was not due to interposition of soft tissues and (2) to discuss the relevance of the finding that the anterior third of the lateral meniscus was attached to the avulsed anterior cruciate ligament insertion site in all patients studied. METHODS: Twelve patients who had had a failed manipulative reduction of a type-III tibial eminence fracture underwent arthroscopic reduction and fixation of the avulsed fragment. RESULTS: A number of consistent findings were noted. The avulsed intercondylar eminence was displaced superiorly into the intercondylar notch. Attached to this fragment was not only the anterior cruciate ligament, but also, in all cases, the anterior horn of the lateral meniscus. The anterior third of the lateral meniscus had been torn from its tibial attachment and displaced together with the osseous fragment into the intercondylar notch. No interposition of bone or soft tissue was observed. Reduction of the osseous fragment was facilitated by traction on, or sutures passed around, the anterior horn of the lateral meniscus. Standard fixation methods were utilized. CONCLUSIONS: The concept that avulsion fractures of the tibial insertion of the anterior cruciate ligament cannot be reduced by manipulation because of soft-tissue interposition was not supported by the findings of the present study. The attachment of the anterior horn of the lateral meniscus to the avulsed tibial insertion of the anterior cruciate ligament may not be an irrelevant incidental finding. The observation that the displaced osseous fragment was attached simultaneously to the anterior cruciate ligament and to the anterior horn of the lateral meniscus, both pulling in different directions, may explain why type-III tibial eminence fractures are irreducible by manipulation.     

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。     

Medial and lateral segond fractures in a skeletally immature patient: a radiographic marker for the multiply injured knee

Marginal fractures of the medial tibial plateau have been reported in the literature as a secondary type of Segond fracture. Some reports described this entity in the setting of combined injuries such as root avulsions of the medial meniscus, complete disruption of the posterior cruciate ligament (PCL), partial tear of the anterior cruciate ligament (ACL), and tears of the medial meniscus and medial collateral ligament. It has been postulated that medial marginal fractures are secondary to compression of the medial aspect of the femoral condyle and tibial plateau with a corresponding posterolateral corner injury. However, this mechanism of injury may not always be as straightforward.This article presents a case of an alternate injury pattern in a skeletally immature patient. A 16-year-old boy sustained a varus force and twisting injury to his knee, resulting in radiographic evidence of multiple avulsion fractures of the knee, including a fibular epiphyseal avulsion fracture and medial and lateral Segond fractures. Usually, the avulsion fractures serve as markers for significant ligamentous injuries in adult patients, but our patient had minimal injury to the PCL, ACL, and posterolateral corner. Further physical examination and imaging studies revealed an anterior horn root avulsion, meniscocapsular separation, and anterior cortical rim fracture. A combination of imaging modalities helped us further characterize the injury pattern to devise the optimal surgical plan, especially the fixation of the anterior cortical fracture of the tibia.