关节镜下双带线锚钉前交叉韧带止点足印重建治疗胫骨髁间嵴撕脱骨折

目的:探讨关节镜下复位、双带线锚钉前交叉韧带(ACL)止点足印解剖重建治疗胫骨髁间嵴撕脱骨折的手术方法及临床疗效。方法:2009年4月～2011年4月,对15例胫骨髁间嵴撕脱骨折患者在关节镜下行骨折解剖复位、双带线锚钉ACL止点足印解剖固定术。胫骨髁间嵴撕脱骨折的Meyers-McKeever分型:Ⅱ型8例,Ⅲ型5例,Ⅳ型2例;男12例,女3例;年龄21～57岁,平均30.6岁。术前前抽屉试验及Lachman试验均呈阳性,Lysholm评分为(49.9±3.7)分,IKDC 2000主观膝关节评分为(53.3±5.3)分。结果:患者均获随访,随访时间9～15个月,平均12个月。术后6个月X线片复查示髁间嵴骨折均愈合,骨折复位良好。末次随访时,患肢膝关节活动范围达0～120°;Lysholm评分为(89.6±3.2)分,IKDC2000主观膝关节评分为(90.8±5.7)分,两项评分与术前比较差异均有统计学意义(t1=22.100,t2=20.700,P=0.000)。结论:关节镜下复位、双带线锚钉ACL止点足印解剖重建治疗胫骨髁间嵴撕脱骨折,有利于实现ACL胫骨止点解剖原点重建,对于恢复ACL正常生理功能有重要意义。

Arthroscopic Footprint Anatomic ACL Reconstruction for Tibial Intercondylar Eminence Avulsion Fracture Using Double-Suture Anchors

Objective To investigate the outcomes of arthroscopic reduction and footprint anatomic ACL reconstruction for treating tibial intercondylar eminence avulsion fracture using double-suture anchors.Methods Between August 2009 and August 2010,15 patients with tibial intercondylar eminence avulsion fracture were treated with arthroscopic reduction and footprint fixation using double-suture anchors.According to Meyers-McKeever classification,8 cases of 15 were rated as type II,5 as type III,and 2 as type IV fractures.Anterior drawer test and Lachman test of all patients were positive.Lysholm and IKDC 2000 scores were 49.9±3.7 and 53.3±5.3,respectively.Results All the patients were followed up for an average of 12 months(9~15 months).The X-ray films showed good reduction and healing of fracture 6 months after operation.At the last follow-up,the range of knee motion was 0~120°.The mean Lysholm scores was significantly improved(89.6±3.2) postoperatively(t = 22.100,P = 0.000).The IKDC 2000 score increased from 53.3±5.3 preoperatively to 90.8±5.7 postoperatively(t = 20.700,P = 0.000).Conclusion Arthroscopic treatment using double-suture anchors for tibial intercondylar eminence avulsion fracture yielded satisfactory reduction and footprint anatomic ACL reconstruction with minimal invasion,simplicity,and effectiveness.