关节镜下治疗胫骨髁间棘骨折

目的探讨关节镜下复位并内固定治疗胫骨髁间棘骨折的手术方法及疗效。方法对14例Meyers-MckeeverⅡ、Ⅲ、Ⅳ的胫骨髁间棘骨折患者施行关节镜下复位及内固定术。在关节镜监视下,对移位或翻转的粉碎骨折块进行复位,用不可吸收缝合线或自攻空心松质骨螺钉对骨折块行内固定,同时处理合并伤。术后使用支具于伸膝位制动4～6周,术后给予相应阶段的康复指导。结果全部患者术后骨折愈合良好,伤膝关节活动度与健侧一致,关节稳定。结论对于胫骨髁间棘骨折,根据患者年龄、骨折类型、选取适合的内固定方式,在关节镜监视下完全可以做到满意的骨折整复,可靠的内固定,重建前交叉韧带的稳定性。关节镜下复位、内固定手术创伤小,较膝关节开放手术具有明显优越性。     

Physeal sparing arthroscopic fixation of displaced tibial eminence fractures: a new surgical technique

We describe a novel physeal sparing arthroscopic technique for anatomic suture refixation of tibial eminence fractures and assess the mid-term results of six consecutive patients (McKeever type II n = 2, III n = 3 and IV n = 1). The mean follow-up was 5 ± 2 years. Five of six patients were painfree. All patients returned to their preinjury sport level. Mean passive ipsilateral and contralateral flexion was 143° ± 5°. The IKDC score was A in five and B in one patients. The mean Lysholm score was 97 ± 3%. The median Tegner score was 8 (range 6–9) preinjury and at follow-up. The mean Total Knee Society score was 197 ± 4 points. ACL laxity (KT-1000 134 N) showed a side-to-side difference of 2 ± 2 mm. Two of six patients underwent a tibial screw removal under local anaesthesia. No loss of reduction or grossly physeal disturbance was observed. The reported surgical technique showed excellent to good clinical and radiological results and may be a physeal sparing alternative to previously described procedures.     

成人胫骨髁间棘撕脱骨折手术治疗的疗效分析

目的 探讨成人胫骨髁间棘撕脱骨折的特点与不同手术方法的疗效.方法 回顾性分析1997年5月-2005年6月31例胫骨髁间棘撕脱骨折患者31例,其中Meyers-McKeeverⅡ型5例,Ⅲ型12例,ZaricznyiⅣ型14例;合并内侧副韧带(MCL)损伤12例,合并胫骨平台骨折10例.包括切开复位内固定(A组)17例和关节镜下复位内固定(B组)14例,进行平均2.9年的随访.结果 两组不同程度伸膝功能异常23例,屈膝功能异常13例.其中A组伸膝功能异常12例,B组异常11例,A组屈膝功能异常8例,B组异常5例.Lachman和前抽屉试验结果A组分别为(1.59±0.44)°和(1.36±0.66)°,B组分别为(1.65±0.45)°和(1.57±0.88)°.A、B两组轴移试验分别为(0.7±0.3)°和(0.8±0.3)°.KT-2000检查前交叉韧带松弛的健侧患侧差别A、B两组分别为(1.5±1.3)mm和(1.7±2.4)mm;Lysholm评分为(96.5±3.3)分和(95.6±3.8)分;Tegner评分为(6.3±0.5)分和(6.2±0.6)分,上述各种指标组间比较差异均无统计学意义(P＞0.05).结论 成人髁间棘撕脱骨折多为粉碎性骨折,容易合并MCL损伤和胫骨平台骨折.手术方法要根据骨折类型、设备条件和技术能力确定,强调完全的解剖甚至适当的过度复位,三维、坚强内固定和早期功能锻炼.     

Delayed recurrent hemarthrosis after staple fixation of tibial avulsion fracture of the posterior cruciate ligament: a case report

This study reports a case of unusual vascular complication related to the staple fixation for the tibial avulsion fracture of the posterior cruciate ligament (PCL). The patient, who experienced recurrent hemarthrosis 12 months after staple fixation for the avulsion fracture of the PCL, was successfully managed by removing the staple and suturing the bleeding focus of the popliteal artery. Injury to the popliteal artery by the prominent staples could be the culprit causing the recurrent hemarthrosis. This type of delayed popliteal artery injury should be kept in mind in open reduction and internal fixation for the tibial avulsion fracture of the PCL.     

Tibial intercondylar eminence fractures in adults: arthroscopic treatment

Results obtained from the surgical treatment of 15 cases of type II and III tibial intercondylar eminence fractures—according to the classification of Meyers and McKeever [12, 13]—are reported in this paper. The average age of the patients observed was 22 years (range 18–41). All patients underwent an arthroscopic procedure of reduction and fixation. We used a bioabsorbable suture in ten patients and a nonabsorbable suture in five patients. The suture was passed at the ACL insertion, then pulled out through drilled tunnels and tied onto the anterior surface of the tibial metaphysis. Two of the 15 patients treated underwent an additional arthroscopic procedure because of arthrofibrosis, 2 months after the first surgical intervention. All patients were examined clinically and radiographically with an average follow-up of 18 months. According to the IKDC scoring system, recovery of the 13 patients not undergoing additional intervention was graded as normal or near normal. In 14 patients, anterior laxity was inferior to 5 mm at the KT-1000 arthrometer evaluation. Absorbable or nonabsorbable suture fixation is effective for obtaining a secure fixation and achieves good clinical and functional mid-term results.     

Type IIIB tibial intercondylar eminence fracture associated with a complex knee dislocation in a grossly obese adult

Avulsion fractures of the intercondylar eminence or tibial spine mostly occur in children and adolescents, and are extremely uncommon in adults. A type IIIB intercondylar eminence fracture (i.e. completely displaced and rotated tibial spine) associated with a complex knee dislocation is an extremely rare combination.     

Treatment of malunited fractures of the anterior tibial spine

Avulsion fractures of the anterior tibial spine are uncommon injuries, and most often seen in childhood. They can be associated with other intraarticular lesions and have, if adequately treated, a good long-term prognosis. In adults these fractures can be complicated by loss of knee extension because of the displacement of the bony fragment. This is most often as a result of non- or malunion of the displaced fragment. We review two cases of malunited fractures of the anterior tibial spine. Both patients reported persistent knee pain and loss of knee extension, and had had an anterior knee laxity for a long time. They had been treated extensively by physiotherapy. In one patient, arthroscopy in another hospital revealed no reasons for the clinical symptoms. More than twenty years after the initial trauma, both patients visited our hospital. A radiograph and a magnetic resonance imaging were respectively carried out both of which revealed a malunited avulsion fracture. According to the examinations, the patients were treated by open reduction and internal fixation, and in the follow up exploration both no longer had discomfort. Clinical and radiological features of this less common and rarely reported injury are discussed and the surgical treatment is demonstrated.     

关节镜下带线锚钉与空心拉力螺钉内固定治疗胫骨髁间嵴撕脱骨折的疗效评价

目的对比分析关节镜下不同内固定方法治疗胫骨髁间嵴撕脱骨折的疗效,为临床治疗提供参考。方法选取钦州市中医医院骨科2014年5月—2015年7月收治的胫骨髁间嵴撕脱骨折患者42例为研究对象,随机抽签法分为锚钉组和螺钉组各21例,锚钉组患者行关节镜下带线锚钉治疗,螺钉组患者行关节镜下空心拉力螺钉内固定治疗,观察两组患者术后切口愈合、膝关节功能变化以及膝关节活动范围。结果两组患者术后切口均I期愈合,无感染情况出现。术后均成功获得随访,随访时间1年以上,术后即刻X线检查示骨折复位良好。术后3个月复查骨折均骨性愈合,无患肢功能障碍。术前两组患者膝关节功能评分差异无统计学意义(P0.05),术后膝关节功能评分均显著提高(P0.05),但锚钉组膝关节功能评分(92.97±3.15)与螺钉组(89.94±3.28)差异无统计学意义(P0.05)。术前两组患者膝关节活动范围差异无统计学意义(P0.05),术后膝关节活动范围显著增加(P0.05),但锚钉组膝关节活动范围(120.6±11.0)与螺钉组(118.5±10.7)差异无统计学意义(P0.05)。结论胫骨髁间嵴撕脱骨折关节镜下带线锚钉和空心拉力螺钉内固定治疗均有很好效果,带线锚钉固定无需二次手术取出,操作简单。     

膝关节镜下多种钢丝固定方法治疗胫骨髁间棘骨折

目的对胫骨髁间棘骨折采用关节镜下钢丝固定的微创手术治疗,探讨不同骨折情况各种钢丝穿入和固定方法,总结此种技术治疗胫骨髁间棘骨折的疗效。方法对15例胫骨髁间棘骨折采用关节镜下钢丝固定的微创治疗方法。根据骨折情况,固定方法包括单钢丝、多钢丝、三角形或交叉钢丝固定方式。术后早期膝关节功能锻炼。随访9—30个月。结果全部患者无感染等严重并发症。1例单钢丝固定者术后4个月钢丝自打结处断裂,骨折移位不明显;2例膝关节活动度受限,其中1例未完成康复治疗,1例为陈旧性骨折。余患者功能恢复正常。结论为恢复膝关节稳定,避免髁间窝撞击等并发症,对明显移位的胫骨髁间棘骨折应早期实施固定治疗。比较开放手术,关节镜下微创手术具有创伤小、并发症少、利于功能恢复等优点。根据骨折情况,可采用单钢丝、多钢丝、三角形或交叉钢丝固定等方式。     

胫骨平台伴髁间嵴骨折手术治疗的临床疗效

目的：探讨开放复位内固定治疗胫骨平台伴髁间嵴骨折的临床疗效。方法2007年6月～2011年6月对收治的42例胫骨平台伴髁间嵴骨折采用切开复位钢板内固定治疗,同时行钢丝固定髁间嵴骨折36例,6例未固定。胫骨平台骨折按Schatzker分型：Ⅲ型8例,Ⅳ型18例,Ⅴ型10例,Ⅵ型6例;胫骨髁间嵴骨折按Meyers McKeever分型：Ⅰ型6例,Ⅱ型17例,Ⅲ型13例,Ⅳ型6例。结果术后1例切口发生脂肪液化并感染,经清创、负压吸引及II期缝合后愈合,余伤口均Ⅰ期愈合。随访12～26个月,平均18个月。末次随访时,患者膝关节伸直均达到0°,屈膝80°～150°,平均122°;膝关节稳定性检查：3例Lachman试验及前抽屉试验（ ADT）为阳性;参照Rasmussen膝关节功能评分标准：优16例,良19例,可4例,差3例;优良率为83.3％。7例发生膝关节创伤性关节炎,3例胫骨髁间嵴骨折未愈合。结论手术治疗胫骨平台伴髁间嵴骨折应重视对髁间嵴骨折的固定,包括无移位的髁间嵴骨折,有利于术后早期功能锻炼及维持膝关节稳定。     

The use of frame fixation in the management of open distal extensor mechanism avulsion fracture in a dislocated knee

An avulsion fracture of the tibial tubercle is a common injury in traffic accident. If the fracture is closed, then a comparatively good prognosis can be expected through reinforcement of the bone via osteosynthesis and the use of artificial ligaments. In this case, an open wound was observed in the tibial tubercle, and the wound was so polluted that the healing process was significantly delayed. It was therefore difficult to provide simultaneous surgical treatment and so three operations were required to perform the reconstruction of the extensor mechanism. The reconstruction of extensor mechanism and the frame fixation between the patella and tibia was performed. Six months after the injury, the patient was able to walk without aid, had a range of movement from 5°to 130°, and did not show any indications of ADL disorder. Using this method of frame fixation between the patella and tibia proved to be an effective technique for the reconstruction of the open knee extension mechanism injury.     

Arthroscopic fixation of anterior cruciate ligament tibial avulsion fractures using bioabsorbable suture anchors

This article describes a new technique for the arthroscopic reduction and fixation of anterior cruciate ligament (ACL) tibial avulsion fractures using bioabsorbable suture anchors. This described technique requires the use of anterolateral, anteromedial, medial mid-patellar, and lateral mid-patellar portals. A suture hook loaded with No. 2 polydioxanone (PDS) was used to pierce the ACL through the anteromedial or anterolateral portal, and bioabsorbable suture anchors were inserted through the medial and lateral mid-patellar portals. The five patients treated using this technique were evaluated at 1 year postoperatively. All patients showed bony union without anterior laxity or flexion contracture. The described technique provides firm fixation of fracture fragment and can be used in both skeletally immature and mature patients.     

交通伤后胫骨髁间棘撕脱性骨折关节镜下治疗

目的 探讨交通伤后胫骨髁间棘撕脱骨折在关节镜下复位、PDS-Ⅱ线固定的治疗方法.方法 在2005年2月～2009年12月间,我科共治疗36例交通伤后急性胫骨髁间棘撕脱骨折.男性25例,女性7例;平均年龄27.5岁(11～55岁).其中Ⅱ型9例(25%),Ⅲ型20例(56%),Ⅳ型7例(19%).手术采用关节镜下骨折复位...     

可吸收螺钉治疗膝后交叉韧带胫骨附着点撕脱骨折

目的 探讨应用可吸收螺钉治疗膝后交叉韧带胫骨附着点撕脱性骨折的治疗效果.方法 2006年1月～2011年1月对16例膝后交叉韧带胫骨附着点撕脱骨折进行可吸收螺钉内固定治疗.结果 经3个月～1年随访,无感染、瘘道形成,无骨折再移位和关节僵硬,16例骨折全部愈合,按HSS膝关节评分法,优13例,良3例,优良率100%.结论...     

A safe postero-medial approach to posterior cruciate ligament avulsion fracture

The posterior cruciate ligament (PCL) plays a major role in knee stabilization, and clinical studies have shown an increase in incidence of its injury. Due to the surrounding neurovascular elements in the popliteal space, open approaches to repair such injury are difficult to perform. The “safe postero-medial approach” to PCL avulsion fracture is a simple approach, does not require exploration of the neurovascular elements, and produced satisfactory results in the majority of patients.     

关节镜下胫骨髁间前棘骨折微创手术不同固定方式治疗效果观察

目的探讨在关节镜下微创空心螺钉内固定和钢丝捆扎固定对胫骨髁间前棘骨折的临床疗效差异。方法笔者回顾性分析2010年5月~2013年5月鄂州市中心医院骨科收治的72例胫骨髁间前棘骨折患者的临床资料,根据术中患者采用的固定方式分为空心螺钉组和钢丝固定组,比较两组患者的临床疗效差异。结果术后第3、6、9个月及末次随访,空心螺钉组患者膝关节Lysholm评分高于钢丝固定组,空心螺钉组患者在术后开始进行膝关节功能恢复训练显著早于钢丝固定组(P0.05);两组患者的骨折愈合时间、随访时间比较差异不具有统计学意义(P0.05)。结论临床患者采用空心螺钉内固定治疗膝关节内骨折,功能恢复效果更佳。     

改良膝关节后侧切口治疗后交叉韧带胫骨撕脱骨折临床分析

目的评价应用改良膝关节后侧切口治疗后交叉韧带胫骨撕脱骨折的方法及疗效。方法回顾分析应用改良膝关节后侧切口切开复位、空心螺钉置入治疗后交叉韧带胫骨撕脱骨折19例。结果本组手术过程顺利,住院期间无感染及下肢深静脉血栓形成等并发症。19例均获门诊复查随访,随访时间6～24个月,平均9个月,获得随访的患者骨折术后均I期愈合,膝关节活动度均正常,Lysholm评分由术前平均65.4分提高至最后一次随访平均96.6分。结论改良膝关节后侧切口治疗后交叉韧带胫骨撕脱骨折是简便、安全的手术入路,可充分显露骨折区域,对骨折进行有效复位、固定。     

Double-bundle anterior cruciate ligament reconstruction using two different suspensory femoral fixation: a technical note

We describe a novel double-bundle reconstruction method for ACL deficient knee. Grafts are tibialis allograft for AMB (anteromedial bundle) and semitendinosus autograft for PLB (posterolateral bundle). Femoral fixations are done by Bio-TransFix for AMB and EndoButton for PLB. Tibial fixations are done by Bio-interference screw for AMB at 60–70° knee flexion and secure the PLB and remnant AMB graft simultaneously onto anteromedial aspect of tibia at 10–20° knee flexion with spiked washer and screw. With our technique, graft lengths are not restricted and we provide strong femoral and tibial fixation if it is compared with previous techniques.     

Avulsion of anterior cruciate ligament from femoral condyle: an unusual case report and a review of the literature

We report a rare case of avulsion of anterior cruciate ligament from the lateral femoral condyle and describe the arthroscopic management of such a case along with a review of the literature.     

Simultaneous anterior and posterior cruciate ligament reconstruction in chronic knee instabilities: surgical concepts and clinical outcome

The purpose of this study was to evaluate the clinical results of simultaneous arthroscopically assisted reconstruction of anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) using autogenous tendon grafts in chronic knee injuries. Nineteen patients (17 men and 2 women) with chronic multi-ligamentous injuries underwent one-stage ACL and PCL reconstruction. ACL, PCL and medial collateral ligament were reconstructed in seven knees, and ACL, PCL and posterolateral structure were reconstructed in two knees. Function of the operated knee was evaluated according to the International Knee Documentation Committee (IKDC) and Lysholm scale. Anterior and posterior knee laxity was examined with a KT-2000 arthrometer. Eighteen of 19 patients were able to return for follow-up and were evaluated objectively and subjectively. The average patient age at surgery was 30.5 years, and the average postoperative follow-up was 3.5 years. No patients showed loss of knee extension more than 5 degrees , while three patients revealed loss of knee flexion more than 16 degrees . The mean postoperative total anterior-posterior side-to-side difference was 1.9 +/- 1.5 mm at 20 degrees and 2.1 +/- 1.9 mm at 70 degrees . The average of the Lysholm score was 95.1 points at the final follow-up. At the IKDC evaluation, three patients were grade A, 11 were grade B, 3 were grade C, and 1 patient was grade D. The results showed the effectiveness and safety of one-stage reconstruction of combined ligamentous injuries of the knee that can adequately restore satisfactory stability.