关节镜下复位空心螺钉固定治疗股骨髁部B型骨折11例临床报道

目的:探讨关节镜引导下微创治疗股骨髁部B型骨折的临床效果及手术适应症。方法:自2009年3月～2011年3月,对11例(11膝)股骨髁部B型骨折患者进行关节镜引导下复位空心螺钉固定术,其中男7例,女4例,年龄平均34.5岁;将骨折依国际内固定研究会(AO)标准分类,B1型3例,B2型4例,B3型4例。清理关节腔后,在关节镜监视下牵引,用点式复位钳不断调整以复位骨折,镜下证实关节面分离<2 mm和骨折的软骨面平整后,打入导针,用空心螺钉固定。结果:全部11例患者均获得随访,平均17个月(10～27个月),术后复查X线片示骨折均解剖对位,术后6月骨折均达到骨性愈合,Lysholm膝关节评分平均为90分(83～95分),膝关节屈伸活动度平均为131°(120～140°)。结论:关节镜引导下复位空心螺钉固定股骨髁部B型骨折具有微创、可视、复位确切等优点,并对合并膝内损伤者具有明显诊治优势。

Clinical Report:Arthroscopy-Guided Hollow Screw Fixation for Treating Type-B Femoral Condylar Fracture

Objective To investigate the clinical effectiveness and surgical indications of arthroscopy-guided hollow screw fixation for type-B femoral condylar fracture.Methods Eleven patients(seven males,four females) with condylar fracture treated with hollow screw in our hospital in recent 2 years were enrolled in this study.According to AO(Arbeitstemeins fur Osteosynthesefragen)’s method,there were 3 cases of type B1,4 cases of type B2,and 4 cases of type B3.After clearing articular cavity,under the monitoring of the arthroscopy,the fractures were fixed by hollow screws after the separation of articular surface was less than 2mm and catagmatic cartilage surface was confirmed smoothly through incessantly adjusting with point reset clamp.Results All the patients were followed up for 10 to 27 months.X-ray postoperative review confirmed that fractures were anatomically registered.Fractures reached synostosis 6 months after operation.The average Lysholm score was 90 points(83~95),and the average knee mobility was 131°(120°~140°) 6 months after operation.Conclusion Arthroscopy-guided hollow screw for treating femoral condylar fracture reveals obvious advantages,including less tissue damage,visibility,and precise reposition.