关节镜下复位固定治疗陈旧性胫骨髁间隆突撕脱性骨折

目的 探讨关节镜下复位固定治疗陈旧性胫骨髁间隆突撕脱性骨折的疗效及影响疗效的因素.方法 2000年1月至2006年12月,对23例有明显临床症状的陈旧性胫骨髁间隆突撕脱性骨折患者行关节镜下骨折端新鲜化、复位、内固定治疗.骨折至手术时间:3个月～8年,平均5.8个月.骨折按Meyers和McKeever分类:Ⅱ型9例,Ⅲ型14例.膝关节功能采用Lysholm评分标准评定:术前为(65.7±3.2)分.术后3周后在支具保护下被动伸屈膝关节,术后4周主动锻炼,并下地部分负重行走.术后6周拆除支具.结果 23例患者术后获平均14个月(6～36个月)随访,X线片示骨折复位满意,愈合良好.膝关节稳定,前抽屉试验和Lachman试验阴性,未发生骨折不愈合和关节僵硬等并发症.术后Lysholm膝关节功能评分为(94.6±2.6)分,手术前、后比较差异有统计学意义(t=2.764,P:0.0082):其中优17例,良5例,可1例,优良率为95.7%.术前9例膝关节有不同程度伸直受限者,随访时除1例仍有50°申膝受限外,其余8例患者均恢复正常.结论 关节镜下复位固定治疗陈旧性胫骨髁间隆突撕脱性骨折,具有骨折对位良好、内固定日J靠等优点,可有效重建膝关节的稳定,改善膝关节功能.

Arthroscopic reduction and internal fixation for non-united avulsion fractures of tibial spine

Objective To study the curative effects and their influencing factors of arthroscopic reduction and internal fixation for non-united avulsion fractures of tibial spine.Methods From January 2000 to December 2006, 23 cases of manifest clinical symptoms of non-united avulsion fracture of tibial spine were treated with arthroscopic reduction and internal fixation.They were 15 males and 8 females, with an average age of 25.4(8 to 47)years.The interval from fracture to operation was averagely 5.8(3 to 96)months.According to Meyers and McKeever classification, there were 9 type 鈪?fractures and 14 type 鈪?fractures.The patients were asked to do passive extension and flexion of the knee with braces 3 weeks after operation, and active exercise and walking with partial weight loading 4 weeks postoperatively.The braces were removed 6 weeks later.Results All the patients were followed up for an average of 14(6 to 36)months.X-ray revealed satisfactory reduction and union of the fractures.The anterior draw test and Lachman test were negative.No complications such as malunion or joint stiffness were found.With an average Lysholm knee score of 94.6±2.6, 17 cases were excellent, 5 cases good and 1 case fair.Conclusions Arthroscopic reduction and internal fixation is effective for treatment of non-united avulsion fractures of tibial spine, due to its complete debridement of scar tissue between bone fragments, good reduction and stable fixation of fractures.Rehabilitation can promote the functional recovery of the knee.