关节镜下复位丝线固定治疗前交叉韧带下止点撕脱骨折

目的探讨关节镜下腰穿针引导不可吸收线固定治疗前交叉韧带(ACL)下止点撕脱骨折的手术方法和疗效。方法2001年1月至2004年12月,关节镜下腰穿针引导不可吸收线固定治疗ACL下止点撕脱骨折30例,按M eyers-M cKeever分型:Ⅱ型8例,Ⅲ型17例,Ⅳ型5例。手术在关节镜下进行,复位骨折片,采用交叉韧带重建钻导器(Acufex PCL gu ide)引导由关节外向关节内骨折块边缘钻孔制成两骨隧道,置入腰穿针,后通过腰穿针穿线,皮下打结固定骨折块治疗。术后无需石膏外固定,康复简单。随访时摄X线片,并进行Lysholm评分。结果30例患者均获得随访,时间3个月~2年,平均(15.0±4.7)个月。所有患者术后恢复良好,无膝关节不稳症状,KT2000检查结果佳,18例新鲜骨折病例获得6个月以上随访,Lysholm评分平均98.4分。4例陈旧骨折病例,术前平均55.0分,术后平均89.8分。结论关节镜下复位丝线固定治疗前交叉韧带下止点撕脱骨折,操作简捷、固定可靠、手术创伤小,术后美观,康复简单、功能恢复良好,并且不需要石膏外固定,不需要二次手术取内固定。新鲜骨折病例效果优于陈旧骨折病例。但需要术者掌握良好的关节镜操作技术。

Arthroscopic treatment of tibial intercondylar eminence avulsion fractures using no absorbable suture fixation

OBJECTIVE: To study the surgical skill and the clinical outcomes of arthroscopic treatment of tibial intercondylar eminence avulsion fractures using no absorbable suture fixation. METHODS: A total of 30 cases with avulsion fractures of the tibial intercondylar eminence were treated with no absorbable suture fixation from January 2001 to December 2004. All procedures were performed arthroscopically by the same surgeons. There were 8 cases of type II, 17 type III, 5 type IV based on the Meyers and McKeever classification and 26 cases were fresh fracture. The procedure was completed with the assistance from No. 18 spine needle and Kirschner wire (?2.0 mm and ?1.0 mm) and director drill guide. Postoperative immobilization was not required. RESULTS: All patients were followed up for 3 to 24 months, average (15.0 +/- 4.7) months. Subjective results of all cases were uniformly excellent. The mean Lysholm score was 98.4 in 18 cases of fresh fracture, and 89.8 in 4 cases of old fracture. Mean KT2000 side-to-side difference was normal in all case. CONCLUSIONS: The technique is simple, safe, reproducible, minimal invasion and effective; postoperative immobilization is not required; knee joint function is excellent.