Fractures of the intercondylar eminence in children and adolescents

The treatment of choice of completely dislocated fractures of the intercondylar eminence is controversial. Recently, Zifko and Gaudernak [14] introduced a new classification in which they distinguish between two different types of intercondylar fractures: Type A: isolated avulsion of the anterior cruciate ligament Type B: fractures including the intercondylar eminence In order to assess whether this new classification could lead to a better selection of patients requiring open reduction, 19 children were reviewed 2-16 years after they had sustained a fracture of the intercondylar eminence. All patients with incompletely displaced fragments had an excellent or good ultimate result, independent of the kind of initial treatment received. Eleven patients sustained a complete displaced fracture. Of these, two had a poor result. Both had been treated conservatively for isolated avulsion of the anterior cruciate ligament. All conservatively treated type-B fractures had an excellent or good result. It is concluded that completely displaced type-A fractures require operative treatment by open reduction and fixation of the avulsed fragment.     

Fractures of the intercondylar eminence in children and adolescents

The treatment of choice of completely dislocated fractures of the intercondylar eminence is controversial. Recently, Zifko and Gaudernak [14] introduced a new classification in which they distinguish between two different types of intercondylar fractures:

关节镜下手术治疗儿童胫骨髁间棘骨折

目的:探讨关节镜下抽出钢丝固定治疗儿童胫骨髁间棘骨折的临床疗效。方法:自2008年10月至2010年12月,手术治疗儿童胫骨髁间棘骨折21例,男14例,女7例;年龄7~14岁,平均10岁;手术时间为伤后3~8 d,平均4 d。术前常规摄X线片,行CT扫描或MRI检查了解骨折情况及关节损伤情况;手术全部采用关节镜下抽出钢丝固定治疗;术后早期功能锻炼,摄X线片了解术后情况,并采用Lysholm膝关节评分进行临床症状和功能评分。结果:所有患者骨折愈合,Lysholm膝关节评分由术前的30.2±4.2提高至术后的92.8±9.1;优18例,良3例。结论:关节镜下抽出钢丝治疗儿童胫骨髁间棘骨折的优点是经济,固定牢固,属于稳定性固定,且钢丝直径小而光滑,对骨骺医源性损伤较小。     

关节镜下儿童胫骨髁间棘骨折的微创治疗

目的：分析儿童胫骨髁间棘骨折的特点,介绍关节镜辅助下微创治疗的方法。方法：对2004年1月至2008年12月12例儿童胫骨髁间棘骨折进行回顾性分析。按照Meyers-McKeever骨折分型：Ⅰ型1例,Ⅱ型4例,Ⅲ型7例。新鲜骨折10例,陈旧骨折2例;男10例,女2例;年龄8～13岁,平均10岁。所有病例进行了关节镜探查、复位,克氏针固定。随访时间10～36个月,了解骨折愈合、关节活动度、膝关节稳定性等情况。合并半月板损伤1例,滑车区软骨损伤1例,半月板嵌入骨块下5例。结果：骨折愈合时间平均5周,无畸形愈合、骨不连,无髁间窝撞击表现。术后3个月Lysholm膝关节功能评分平均（92.7±2.5）分,术后6个月平均（96.4±1.7）分,所有患膝恢复健侧活动度。结论：儿童胫骨髁间棘骨折以Ⅱ、Ⅲ型多见,软骨及半月板等关节內合并伤少见。关节镜辅助下交叉克氏针固定法操作简便、手术创伤小、恢复快,符合儿童骨生长快的特点。     

关节镜下手术治疗儿童陈旧性胫骨髁间棘撕脱骨折

目的 探讨关节镜下手术治疗儿童陈旧性胫骨髁间棘撕脱骨折的疗效. 方法 2000年7月～2005年7月治疗16例儿童陈旧性胫骨髁间棘撕脱骨折患者,其中男10例,女6例;根据Meyers ＆ McKeekver及Zaricznyj分型:Ⅱ型9例,Ⅲ型5例,Ⅳ型2例.手术完全采用关节镜下技术:首先清理骨折两端,使用探针撬拨复位骨折块并临时维持复位,通过高位前内入路钻入1枚或数枚克氏针临时固定骨折块,术中X线机透视,骨折复位理想且克氏针未穿过骺板,沿克氏针拧入AO/ASIF中空钛质螺丝钉加垫片固定. 结果术后随访6～24个月,平均18.3个月;所有患者骨折均完全愈合,膝关节活动度均正常.Lysholm评分术前为(49.0±11.5)分,术后末次随访时为(90.0±8.6)分,差异有统计学意义(t=1.375,P＜0.05);IKDC评分术前为(53.3±11.7)分,术后末次随访时为(97.0±3.0)分,差异有统计学意义(t=14.648,P＜0.01).结论 关节镜下使用空心螺钉加垫片不伤及骺板方法固定儿童陈旧性胫骨髁间棘撕脱骨折,安全可靠,治疗效果好.     

关节镜下治疗胫骨髁间棘撕脱骨折

目的介绍胫骨髁间棘撕脱骨折在关节镜下复位、空心钉固定的治疗方法。方法2003年2月至2005年9月,共治疗40例胫骨髁间棘撕脱骨折,均为急性损伤。男24例,女16例;平均年龄29.5岁(11～58岁)。其中运动伤21例(52.5%),交通伤14例(35.0%),日常生活伤5例(12.5%)。依据Meyers&McKeever和Zaricznyj分型标准,40例骨折中,Ⅱ型4例(10%),Ⅲ型24例(60%),Ⅳ型12例(30%)。手术完全采用关节镜下技术:首先清除关节腔内积血和凝血块,然后清理骨折端,骨折复位后通过髌骨内上缘入路打入2～3枚导针暂时固定,术中摄X线片示骨折复位理想后,沿导针拧入1～2枚空心钉固定。结果术后平均随访时间20.1个月(6～37个月)。除1例外,骨折均完全愈合。Lachman试验均为阴性;KT-1000测量胫骨最大前移,与健侧差值平均为0.625mm($1～2mm);Lysholm评分平均98.3分(87～100分)。关节活动度正常者34例,屈膝活动受限者5例,但均<10°。1例患者术后膝关节伸屈范围0°-30°-45°,关节镜下行二次膝关节松解手术,术后膝关节伸屈范围0°-10°-80°。8例患者存在轻度膝前疼痛。4例骨骺未闭合的年轻患者,均在术后10～12周时取出内固定空心钉,末次随访时骨折均完全愈合,未发现骨骼发育异常。结论关节镜下空心钉固定胫骨髁间棘骨折是一种简单、安全及有效的方法,同时适用于儿童和成人患者。     

关节镜下治疗胫骨髁间隆起撕脱骨折

[目的]探讨火节镜下胫骨髁间隆起撕脱骨折的治疗。[方法]自1999年7月－2005年7月对19例胫骨髁间隆起撕脱骨折的患哲在关节镜下行骨折复位、内固定。[结果]随访8—50个月，平均18．2个月，优良率为94．7％。[结论]关节镜下治疗胫骨髁间隆起撕脱骨折创伤小，骨折复位好、固定可靠，操作较为简单，是治疗胫骨髁间隆起撕脱骨折的首选方法。     

关节镜下治疗胫骨髁间嵴陈旧撕脱骨折

2014年1月~2017年1月,我科采用关节镜下移位骨块部分切除治疗20例胫骨髁间嵴陈旧撕脱骨折患者,疗效满意,报道如下。1材料与方法1.1病例资料本组20例,男12例,女8例,年龄18~55岁。经X线、CT、MRI检查证实Meyers-McKeever分型均为Ⅱ型,骨折均已畸形愈合,前交叉韧带尚有良好的附着,张力基本能保持前向稳定。患者临床症状以膝关节伸直受限为主。伤后至手术时间为3个月~2年。1.2治疗方法腰麻或硬膜外麻醉。前内、外侧入路入镜,重点探查骨折块及骨折床,骨折块由于前交叉韧带的牵拉,向后上方翘起,关节镜下看不到骨折线。     

关节镜下固定移位的胫骨髁间嵴撕脱性骨折

目的探讨关节镜下应用钢丝固定移位的胫骨髁间嵴撕脱性骨折的临床效果。方法自2003年1月至2010年12月对35例移位的胫骨髁间嵴撕脱性骨折患者在关节镜下应用钢丝固定,根据Meyers和McKeever分型,Ⅱ型17例,Ⅲ型14例,Ⅳ型4例。术后X线观察骨折愈合。根据Lysholm评分评价膝关节功能,配对t检验比较术前和随访末膝关节功能。结果平均随访时间（16.94±3.06）个月,无切口及关节内感染。术后X线检查显示骨折解剖复位,骨折平均愈合时间（11.91±4.30）周,随访末平均Lysholm评分（92.63±5.46）分,与术前（27.49±10.83）分比较,差异具有统计学意义（t=61.29,P〈0.05）。结论关节镜下应用钢丝固定移位的胫骨髁间嵴撕脱性骨折适用范围广,操作简单,具有创伤小,固定可靠,并发症少,关节功能恢复快,内固定物关节外取出方便的优点。     

Arthroscopic evaluation after surgical repair of intercondylar eminence fractures

Introduction Patients who undergo surgical repair of intercondylar eminence fracture may have postoperative problems despite good reduction. We used arthroscopy to evaluate the outcomes after surgery to repair intercondylar eminence fractures. Materials and methods Ten patients (8 men and 2 women; average age at the time of surgery 27.9 ± 10.0 years, range from 14 to 50 years) with fracture of the tibial intercondylar eminence underwent an arthroscopic reduction and internal fixation with non-absorbable sutures. Preoperative radiological examination showed that there were one Meyer’s type-II, eight type-IIIA and one type-IIIB fractures. Clinical symptoms and physical findings for all the patients were evaluated 1 year postoperatively. Radiographic assessment and the Lysholm rating scale were also utilized. Second-look arthroscopy was performed after 1 year when removing the implant. Arthroscopy was used to assess the appearance of the surface of the anterior cruciate ligament (ACL), check for the existence of cyclops and look for interposition of tissue in the lateral and medial joint spaces. Results One year after the surgery, all ten patients achieved bony union and had negative Lachman and anterior drawer tests. The average Lysholm knee score was 94.5 ± 7.2 points (range 100–75 points). Arthroscopy showed an irregular surface on the ACL in two of the ten patients, cyclops in two patients, interposition in the lateral joint space in two patients and interposition in the medial joint space in one patient. In the two cases seen with an irregular surface, the ACL was covered with droopy fibrous tissue, but the substance of the ACL was intact. The two patients who had cyclops showed loss of knee extension (5°∼10°), which was regained by subsequent resection of the cyclops. One patient who had an interposition into the lateral joint space complained of catching, which was released by resection of the interposing tissue. Conclusion Arthroscopic refixation of the intercondylar eminence fracture provided bony union and a good clinical outcome. Cyclops syndrome is one of the causes of loss of knee extension, and soft tissue in the medial or lateral compartment is one of the causes of catching of knee after surgical repair of intercondylar eminence fracture. Cyclops syndrome, which may occur following ACL reconstruction, is one of the causes of loss of knee extension after surgical repair of intercondylar eminence fracture. In patients who have knee complaints, such as catching and loss of knee extension, a second-look arthroscopy is useful for identifying and correcting the problem.     

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.     

关节镜手术治疗胫骨髁间隆突撕脱性骨折

目的 介绍一种对胫骨髁间隆突撕脱骨折及其合并症的微创治疗途径。方法 在关节镜直视下对26例26膝Ⅱ型以上前交叉韧带胫骨髁间隆突撕脱骨折复位，用φ2．0mm套管针自胫骨结节顶点内下钻孔至撕脱骨块骨折端两侧缘，用硬膜外导针导引φ1．3mm的固定钢丝经胫骨撕脱骨块上缘穿过前交叉韧带附丽部，引导钢丝贯穿前交叉韧带至撕脱骨块两缘，再用φ0．6mm的引导钢丝将固定钢丝的两端经骨块侧缘套管引出关节外打结固定，镜下探查膝关节，清除关节内游离的碎骨块，处理合并的半月板损伤。结果 对所有病例进行8～42个月的随访，全部获得了骨性愈合，25例膝关节功能恢复正常。结论 关节镜直视下治疗胫骨髁间隆突撕脱骨折及其合并症，重建前交叉韧带的稳定性，手术简单，可靠易行，创伤小，恢复快，花费少，是一种较理想的手术方法。     

关节镜下空心螺钉内固定治疗胫骨髁间嵴骨折

正2012年7月~2015年1月,我科在关节镜下应用空心螺钉内固定治疗12例胫骨髁间嵴骨折患者,疗效满意,报道如下。1材料与方法1.1病例资料本组12例,男9例,女3例,年龄18~47岁。左侧5例,右侧7例。按Meyers-McKeever分型:Ⅱ型5例,Ⅲ型7例。受伤至手术时间3~     

关节镜辅助下Orthcord线捆扎治疗青少年髁间棘撕脱骨折

目的 探讨关节镜辅助下采用Orthcord线捆扎治疗青少年髁间棘撕脱骨折的方法和疗效。方法 2013年1月至2014年1月,本科室收治青少年髁间棘撕脱骨折共25例,男18例,女7例;年龄8-16岁,平均年龄13岁;根据Meyers-Mckeever-Zaricnyi骨折分型,II型15例,III型10例(IIIA型6例,IIIB型4例),25例患者均采用在关节镜下先清理骨折残端后Orthcord线捆扎复位固定骨折,并采用Orthcord线捆扎固定。结果 术后随访共24例,随访时间12月,术后3个月,6个月,12个月前抽屉试验和Lachman试验均为阴性。术后3个月,6个月,12个月Lysholm膝关节评分分别为：3月(85.00±2.2),6月(89.25±4.11),12个月(97.25±2.83)。所有患者膝关节功能恢复良好。结论 关节镜辅助下Orthcord线捆扎的方法固定髁间棘撕脱骨折,固定牢固,效果肯定,是一种安全,有效的治疗青少年髁间棘撕脱骨折的方法。     

Arthroscopic fixation of intercondylar eminence fractures using a 4-portal technique

Purpose: We report an easy-to-use 4-portal technique for arthroscopic treatment of intercondylar eminence fractures and compare results of 2 groups of cases, adolescents and adults, and 2 types of internal fixation, sutures and screws. Type of Study: Surgical technique and retrospective study. Methods: The study was carried on 2 groups of patients, adolescents and adults, with intercondylar eminence fractures who were treated arthroscopically. For internal fixation, sutures were used in 8 adolescents and screws were used in 13 adults. In the technique we describe, anteromedial superior and inferior, and anterolateral superior and inferior portals were used. Results: The average follow-up period for the adolescents was 27.3 months (range, 11 to 57 months), and for the adults was 19.6 months (range, 7 to 71 months). We did not encounter any cases of nonunion. There were only 3 complications, 1 of arthrofibrosis resulting from a delay of rehabilitation due to a vascular compromise and 2 cases of tenderness over the screw that responded well to its removal. Union occurred earlier in adolescents, but rehabilitation was easier in adults. Conclusions: Beside satisfactory results obtained by arthroscopic treatment of intercondylar eminence fractures, arthroscopy also provides the possibility to determine and treat associated pathologies. With the experience we gained, the procedure with the 4-portal technique in treating these fractures became much easier as a routine approach.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 17, No 5 (May-June), 2001: pp 450–460     

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 reduction and suture fixation of displaced tibial intercondylar eminence fractures in adults

Introduction Tibial intercondylar eminence fractures are uncommon. In a review of the literature, most authors agreed that conservative treatment was suggested for non-displaced fractures. Displaced fractures were considered an indication for surgery.Materials and methods Between April 2000 and November 2001, five adult displaced tibial eminence fractures were treated by arthroscopic reduction and non-absorbable suture fixation. Postoperatively, the knee was immobilized in a hinged knee brace locked in full extension with non-weight bearing for 4 weeks. Range of motion and quadriceps-strengthening exercises were started 4 weeks later. Partial weight-bearing was allowed in the following 4 weeks.Results The average follow-up was 24.6 months (range 18–36 months). Subjectively, there was no instability or residual pain in the knee. The patients were able to resume their normal activities. Objectively, the average Lysholm Score was 95.6 (range 93–98). The average knee range of motion was 2° to 135° (range 0°–140°). All patients had a negative Lachmans test and no pivot shift phenomenon. All fractures showed good union according to radiological evaluation.Conclusion Arthroscopy-assisted screw fixation is more stable, and it allows early exercise. However, the fragment must be large enough to be fixed with a screw. Comminuted or small fragments present limitations for screw fixation techniques. We used the non-absorbable intraligmentous suture to pull down the fragment regardless of small size or comminuted status. The technique is simple and provided secure fixation without damage to the ACL insertion. A second operation is not required to remove the hardware.     

关节镜辅助下Orthocord线捆扎治疗青少年髁间棘撕脱骨折

目的：探讨关节镜辅助下采用Orthocord线捆扎治疗青少年髁间棘撕脱骨折的方法和疗效。方法2013年1月至2014年1月,本科室收治青少年髁间棘撕脱骨折共25例,均采用在关节镜下先清理骨折残端后Orthocord线捆扎复位固定骨折,术后采用前抽屉试验、Lachman试验、Lysholm评分等评价治疗效果。结果术后随访共24例,随访时间12个月,术后3、6、12个月前抽屉试验和Lachman试验均为阴性,且Lysholm膝关节评分分别为(85.00±2.20)分、(89.25±4.11)分和(97.25±2.83)分。所有患者膝关节功能恢复良好。结论关节镜辅助下Orthocord线捆扎的方法固定髁间棘撕脱骨折,固定牢固,效果肯定,是一种安全、有效的治疗青少年髁间棘撕脱骨折的方法。