关节镜下Spin螺钉固定治疗膝关节髁骨软骨骨折

目的探讨关节镜下Spin螺钉固定治疗膝关节髁骨软骨骨折的可行性及临床疗效。方法2005年11月~2006年2月间收治3例膝关节骨软骨骨折,均为男性,年龄18~29岁,平均24.2岁,均有明确的运动受伤史。所有患者术前浮髌试验( ),前、后抽屉及内、外间隙侧方应力试验均(-)。X线及MRI可见股骨髁骨软骨骨折,其中外髁骨软骨骨折2例,内髁1例。3例患者在伤后3~9d行关节镜下关节腔清理骨软骨骨折块复位、Spin钉固定术。术后于伸直位夹板固定非负重扶拐行走6周,3例患者分别于术后7~12周(平均9.3周),再次关节镜下取出Spin钉,并观察镜下骨软骨愈合情况。Spin钉取出术后6周开始负重行走,评估患者功能恢复情况。结果所有患者术中发现骨软骨骨折块均无明显碎裂,游离于关节腔。1例骨折复位后基本覆盖骨折面;其余2例复位后仍有部分区域骨软骨面缺损,所有患者均未见ACL、PCL、半月板及内外支持带结构损伤,1例伴有髌骨的软骨Ⅲ°~Ⅳ°损伤。二次关节镜下取螺钉术中,见固定物无松脱,取出Spin钉后骨折块完全稳定愈合,其表面软骨无明显退变;2例患者在骨折块不能覆盖行微骨折部位有软骨样组织形成并充填缺损区域,表面欠完整。随访6~8个月,患者膝关节活动恢复正常,无疼痛、积液症状,无任何并发症。二次关节镜取出Spin钉后,1周内患者膝关节活动正常,无活动受限。6周后开始负重行走,螺钉取出后3个月行X线及MRI见髁缺损消失,骨软骨下骨折线已无明显高信号,螺钉道周围仍有少量高信号。结论关节镜下复位利用Spin钉固定骨软骨骨折块,不但能实现骨折块的原位固定愈合,而且大大减少了手术的创伤及并发症的出现。

Treatment of osteochondral fracture in condyle of knee using arthroscopic fixation of spin screw

Objective To evaluate the use of Spin screw in arthroscopic treatment of osteochondral fracture in condyle of knee.Methods From November 2005 to February 2006,3 patients with osteochondral fractures condyles in were diagnosed and treated with arthroscopic fixation using Spin screw.All patients had sports trauma as the cause for their symptoms.Physical exam : floating patella test( ),ADT,PDT(-).Xray and MRI: osteochondral fractures in external condyles,2 case;osteochondral fracture in internal condyle,1 case.All patients undergone arthroscopic probe and osteochondral fracture was ensured.Reduction of fracture and fixation of Spin screw was operated in all patients under arthroscopy.Healing of fractures was observed.Results During arthroscopic detection,it is ensured that ACL,PCL,meniscus and patellar retinaculum were not injured.Osteochondral fracture and fragments were fund and reduction was operated.Fragment completely covered osteochondral defect in one case;in other cases,there was part of osteochondral defect that could not be covered. Osteochondral fragments was stable in situ after fixation of Spin screw.All patients underwent second look of arthroscopy 7-12 weeks post-op eration for taking out Spin screw.Fractures were healed.There was no complication in this series.Conclusion Arthroscopic surgery appears to be satisfactory management for osteochondral fracture in condyle of knee with less surgical morbidity,earlier rehabilitation,the potential benefits of improved joint visualization.Arthroscopic fixation of Spin screw can get healing of osteochondral fracture.