切开复位内固定治疗伴有前、后交叉韧带止点部撕脱的胫骨平台骨折

2009年2月～2011年6月,我科对10例伴有前、后交叉韧带止点部撕脱的胫骨平台骨折患者行手术切开复位内固定,取得满意效果。1材料与方法1.1病例资料本组10例,男6例,女4例,年龄20～60岁。车祸伤6例,高处坠落伤4例,均为闭合伤。SchatzkerⅡ～Ⅴ型患者4例,后侧平台骨折患者6例。患者均伴有前、后交叉韧带胫骨止点部撕脱骨折。     

Bilateral simultaneous anterior cruciate ligament reconstruction: A case series and review of the literature

Bilateral ACL rupture is a relatively uncommon injury with an incidence of 2–4%. Most bilateral ACL rupture occurs at two different times, but few cases of single-staged bilateral ACL ruptures have also been reported. There have been reports of both single-staged, and two-staged reconstruction of bilateral ACL ruptures in the literature but without a clear consensus. We present a series of five bilateral ACL rupture cases managed by single-staged arthroscopic ACL reconstruction, using quadrupled hamstring grafts. All of them were young males, with an average age of 26.8 years (Range: 19–39 years). Three out of five of these cases (60%) had sustained the injury to both the knees simultaneously while playing sports. All the five patients had generalized joint laxity with significant hyperextension of their knees. All the ten knees (in five patients) were clinically stable, at their last follow-ups. None of the knees had any early or late complications. A single-staged bilateral ACL reconstruction is a safe, reproducible, and cost-effective procedure for patients with a bilateral ACL deficient knee, in experienced hands.     

Isolated posterior cruciate ligament injuries associated with closed tibial shaft fractures: a report of two cases

Introduction  Knee ligament injuries associated with tibia shaft fractures are usually neglected and treatment is delayed. To our knowledge, no case presentation discusses the clinical result of closed tibial shaft fracture with concomitant ipsilateral isolated PCL injury. In this literature, we report the clinical result of two cases that sustained closed tibial shaft fracture with concomitant PCL injury and discuss the treatment options. Materials and methods  We report the clinical result of two cases that sustained closed tibial shaft fracture with concomitant posterior cruciate ligament (PCL) injury. Case 1 received open reduction with plate fixation for the tibial shaft fracture, and he also received arthroscopic reconstruction of PCL with bone-patellar tendon-bone graft due to neglecting PCL injury 5 months later after fracture fixation. Case 2 sustained left tibial-fibular shaft fracture with isolated PCL injury confirmed by magnetic resonance image on the first day of injury. She received tibia fixation with intramedullary nail and conservative treatment with bracing and rehabilitation for PCL injury. Results  In case 1, the male patient only focused on fracture healing without any knee rehabilitation. His knee flexed deeply for protected weight bearing in the injured leg which may have exacerbated the posterior instability and reduced the possibility of PCL healing. The end result of knee function was poor even though PCL reconstruction was done later. In case 2, the female patient with diagnosed posterior cruciate ligament injury on the day of injury, her knee was immobilized in brace with full extension, which improved PCL healing. In addition, she received rehabilitation of quadriceps strengthening, and hamstring muscle contraction was avoided in her daily activity. After rehabilitation, the female patient did not complain of severe subjective instability even with an obvious posterior translation on posterior drawer test. Conclusions  We need to perform a careful physical examination of ipsilateral knee in cases of leg fractures, and MRI of knee before surgery if any doubt exists. However, a further research is needed to conclude on the best operation and rehabilitation program in patients with combined tibial shaft fracture and PCL injury. No support from any institution was gained for this study.     

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。     

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     

异体肌腱重建膝关节前交叉韧带失效翻修处理1例及文献回顾

正患者,男,27岁,右膝关节疼痛并关节不稳1个月入院。患者7年前因右膝前交叉韧带损伤在某院行同种异体肌腱前交叉韧带重建术,术后膝关节红肿,切口渗出,考虑存在异体肌腱排异反应,应用抗生素、激素治疗10 d。入院前1个月打篮球时扭伤右膝部,出现膝关节疼痛、不稳。MRI检查示:右膝关节     

Trantibial anterior cruciate ligament double bundle reconstruction technique: two tibial bundle in one tibial tunnel

The anterior cruciate ligament (ACL) consists of two functional bundles that behave independently throughout the range of knee motion. Many two-bundle reconstruction techniques have been introduced to restore the function of the two bundles of the ACL. Generally, two femoral and two tibial tunnels are made during the surgery for a two-bundle ACL reconstruction. However, the procedure is technically demanding and time consuming. This paper describes one-tibial-two-femoral ACL double bundle reconstruction technique with a sextuple-stranded hamstring autograft. The anteromedial femoral tunnel is made using transtibial drilling technique and posterolateral femoral tunnel is made using outside-in technique. The two bundles in a single tibial tunnel are separated using biodegradable interference screw. Stable and adequate femoral fixation of the two bundles with a transtibial fixation and bioabsorbable screw can be obtained. This technique is relatively simple, and replicates the anatomy and differential behavior of the two native bundles of ACL more effectively.     

Insufficiency fracture of the tibial plateau after anterior cruciate ligament reconstructive surgery: a case report and review of the literature

Peri-articular fractures after anterior cruciate ligament (ACL) reconstructive surgery are rare. To our knowledge, this case documents the first insufficiency fracture of the tibial plateau after ACL reconstruction, which presented three weeks after the procedure. A 25-year-old female recreational soccer player suffered an insufficiency fracture of the tibial plateau, extending 1.5 mm into the anterior wall of tibial tunnel and medial compartment under the anterior horn of medial meniscus, which presented as a diagnostic challenge. Clinically, the fracture mimicked a low-grade infection of the surgical site, while radiographically, the fracture resembled an avulsion fracture, later confirmed as a tibial tunnel fracture with computed tomography. With the ACL graft integrity not in jeopardy, four weeks of non-weightbearing and a delayed post-operative rehabilitation program was effective in allowing the fracture to heal. Good functional outcome was achieved after conservative management, with minimal loss of terminal knee extension and minimal pain at 22-month follow-up.     

胫骨残端长度对前交叉韧带重建术后本体觉恢复的影响

目的:研究保留韧带胫骨残端的长度对前交叉韧带重建术后膝关节本体觉恢复的影响.方法:自2011年3月至2011年12月于我院骨科就诊的42例前交叉韧带重建患者分为3组,每组14例.A组保留韧带胫骨残端长度15～20 mm,男8例,女6例,平均年龄(28.2±6.6)岁;B组保留韧带胫骨残端5～10 mm,男9例,女5例,平均年龄(27.9±6.4)岁;C组保留韧带胫骨残端小于2 mm,男9例,女5例,平均年龄(28.6±6.8)岁.治疗前后采用Lachman试验、前抽屉试验对稳定性进行评价,行Lysholm评分和Tegner评分评价关节功能,采用非负重位被动重复位置法对膝关节本体觉进行检测.结果:3组患者术后6个月Lachman试验、前抽屉试验均为阴性,12、18个月3组各1例前抽屉试验呈弱阳性.术后18个月Lysholm和Tegner评分均高于术前,而术后18个月3组间差异无统计学意义.屈曲20°和伸直80°、20°测试重复位置觉显示,3组在治疗前后差异无统计学意义.屈曲50°和伸直50°测试重复位置觉显示,A组和B组在术后6个月较治疗前好转,且明显优于C组;术后18个月3组差异无统计学意义.屈曲80°测试重复位置觉显示,A组和B组在术后12个月较治疗前好转,且明显优于C组;术后18个月3组差异无统计学意义.结论:保留韧带胫骨残端有助于前交叉韧带重建术后早期本体觉的恢复,残端长度以5～10 mm为宜.     

Laxity and functional outcome after arthroscopic reduction and internal fixation of displaced tibial spine fractures in children

Purpose: The purpose of this study was to evaluate laxity and functional outcome of displaced tibial spine fractures in skeletally immature patients treated with arthroscopic reduction and internal fixation. Type of Study: Retrospective case series. Methods: Six patients (mean age, 12.0 years old) underwent subjective, objective, and instrumented knee laxity assessment at minimum 2 years (mean, 3.2 years) of follow-up time after arthroscopic reduction and 3.5-mm cannulated screw fixation of (Meyers and McKeever type III) tibial spine fractures. Results: Physical examination showed persistent laxity, with an abnormal Lachman examination in 5 of 6 patients and an abnormal pivot-shift examination in 2 of 6 patients. Instrumented knee laxity (KT-1000) showed greater than 3-mm manual-maximum side-to-side difference in 4 of 6 patients. Functional assessment revealed excellent function, with a mean Lysholm score of 99.5 (range, 98–100), mean Marshall score of 49.0 (range, 47–50), and mean Tegner score of 8.7 (range, 7–9). Conclusions: Arthroscopic reduction and internal fixation of type III tibial spine fractures in skeletally immature patients results in persistent laxity but excellent functional outcome.     

Salmonella infection after anterior cruciate ligament reconstruction: A case report

BACKGROUNDInfections after anterior cruciate ligament reconstruction (ACLR) are rare. No cases of Salmonella infection have been described to our knowledge.CASE SUMMARYWe describe a rare case of Salmonella infection in a 23-year-old patient following an ACLR. The patient presented with subacute septic arthritis, 26 d after a hamstring autograft ACLR. The pathogen, Salmonella enterica typhimurium was isolated by bacteriological sampling of the first arthroscopic lavage. Two arthroscopic lavages were required, with intravenous antibiotic therapy for two weeks with cefotaxime and ciprofloxacin, followed by oral antibiotics with amoxicillin and ciprofloxacin for a total duration of three months. This approach treated the infection but two years after the septic arthritis, faced with ongoing knee instability due to graft damage, a revision ACLR with a bone-tendon-bone graft was performed. At the last follow-up, full range of knee motion had been achieved and sports activities resumed.CONCLUSIONInfection after ACLR is rare and requires an early diagnosis and management in order to treat the infection and prevent arthritis-related joint cartilage destruction and damage to the graft.     

Open reduction and internal fixation versus hybrid fixation for bicondylar/severe tibial plateau fractures: a systematic review of the literature

Introduction  Bicondylar/Schatzker 6 type tibial plateau fractures are a significant challenge to the trauma and orthopaedic surgeon. These injuries tend to be complex, high energy and are activated with significant morbidity. Two surgical methods are commonly in use: (1) hybrid external fixation or (2) internal fixation. We performed a systematic analysis of papers comparing these two techniques. Methods  The Medline database was used and the MeSH terms associated with bicondylar/severe tibial plateau fractures were inserted. Results  Forty-nine studies were retrieved but only five papers presented data to directly compare the two techniques as these studies actually compared the implants. Study designs and outcome measures were not consistent in all studies and therefore no direct comparison could be made between the papers. The first two studies were laboratory based and suggested that hybrid external fixation may have a benefit over internal fixation with respect to failure load and its use in compromised bone. Two further papers presented only type 4 evidence. The final paper was a multicentre randomised controlled trial and it demonstrated a marginal non-significant benefit of hybrid external fixation over internal fixation although there was suggestion of beta error [i.e. accepting the hypothesis when it is not true]. Conclusion  Bicondylar/Schatzker 6 type fractures are difficult to manage. The treatment of such fractures, need to pay specific attention to the soft tissue envelope around the knee. Hybrid external fixation has theoretical advantages in terms of the soft tissues but the benefit over internal fixation is modest at best and has not demonstrated improved outcome. Newer fixed angle screw and plate systems are increasingly in use and need comparative studies to determine their role in this complex group of fractures.     

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。     

Anterior cruciate ligament reconstruction in a 75 years old man: a case report with review of literature

Anterior cruciate ligament （ACL） reconstruction is usually recommended for young patients. Several recent articles have however reported comparable outcomes of ACL reconstruction between youth and patients in fourth or fifth age group. But in the literature there are not many reports about ACL reconstruction in patients over 70 years old. We report a case of a successful arthroscopic ACL reconstruction （using single bundle quadrupled hamstring graft） in an active 75-year-old medical practitioner. Successful outcome after ACL reconstruction can be achieved in selected older patients; chronological age is no barrier.     

关节镜与传统切开手术治疗前交叉韧带胫骨止点撕脱骨折疗效的Meta分析

目的:系统评价关节镜与传统切开手术治疗前交叉韧带(anterior cruciate ligament,ACL)胫骨止点撕脱骨折的临床疗效.方法:计算机检索2010年7月至2020年7月Embase,Pubmed,Central,Cinahl,学位论文和论文(ProQuest dissertations and the...     

前交叉韧带重建术中胫骨侧止点无撞击区的定位研究

目的探讨前交叉韧带(ACL)重建术中胫骨隧道无撞击重建区的定位。方法选用10具正常新鲜冷冻尸体膝关节标本,膝关节完全伸直时,标记髁间窝顶延长线和ACL胫骨附着处的交点。膝关节屈曲90°时,测量ACL胫骨附着处上标记点与ACL前缘间的距离及标记点与胫骨棘间区后缘间的距离。然后,再测量标记点前部分的前后径、后部分的前后径和内外径,并计算后部分的面积。结果由ACL胫骨附着处前缘到胫骨棘间区后缘的前后径平均为(21.40±1.17)mm。ACL胫骨附着处标记点前部分的前后径平均为(8.90±0.74)mm(占总前后径的41.59%)。胫骨附着处标记点后部分的前后径平均为(12.50±0.85)mm(占总前后径的58.41%),内外径平均为(10.65±0.97)mm,面积平均为(133.80±21.01)mm2。结论ACL胫骨附着处上标记点的后部分是胫骨隧道无撞击区,位于胫骨棘间区的后缘中点与该点前12.50mm之间,在该区域行ACL重建可以避免移植物与髁间窝顶部的撞击。绝对撞击区位于ACL胫骨附着部前缘与其后8.90mm之间,应尽量避免在此区域内定位胫骨隧道。     

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。     

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。     

关节镜下可吸收空心界面螺钉固定、四股腘绳肌腱重建前交叉韧带

目的探讨关节镜下可吸收空心界面螺钉固定、四股自体腘绳肌肌腱重建前交叉韧带(anterior cruciate ligament,ACL)的方法及疗效. 方法关节镜下以四股自体腘绳肌肌腱作为ACL替代物,应用(96L-4D)SR-PLA聚丙交酯生物可降解界面螺钉进行移植物固定, 对42例ACL损伤行ACL重建术. 结果 42例术后随访3～22个月,平均11.4月,膝关节活动度均在正常范围.术后Lachman 试验:37例≤1 ,4例2 ,1 例3 .轴移试验:42 例均为阴性.术后Lysholm 评分(89.7 ±9.6)分较术前(49.4±9.1)分显著提高(t=2.12,P=0.038).术后Tegner 活动评分(5.3±1.1)分较术前(2.3±0.7)分显著提高(t=4.13,P=0.008).术后1年MRI示29例可吸收空心界面螺钉部分被吸收;27例重建的韧带位置良好、形态正常;2例韧带在股骨的止点偏前;3例胫骨止点偏前,有轻度顶撞击现象. 结论四股腘绳肌腱是ACL重建的理想替代材料,可吸收空心界面螺钉是ACL重建的理想内固定材料.     

关节镜辅助复位内固定与切开复位内固定治疗胫骨平台骨折的疗效比较

目的:比较关节镜辅助复位内固定（ARIF）和切开复位内固定（ORIF）治疗胫骨平台骨折的疗效。方法:回顾性分析2016年1月至2018年8月华中科技大学附属协和医院骨科收治的75例胫骨平台骨折患者的资料。男58例,女17例;年龄20~54岁,平均47岁。左侧42例,右侧33例。骨折根据Schatzker分型：Ⅰ型23例...