关节镜下骺板近侧缝线固定治疗儿童胫骨髁间棘骨折的疗效观察

目的总结经骺板近侧缝线固定,治疗儿童胫骨髁间棘骨折的手术效果。方法 2005年5月～2009年5月武汉协和医院骨科收治的儿童胫骨髁间棘骨折病例34例,按Meyers-Mckeever骨折分型:Ⅱ型23例,Ⅲ型11例。在关节镜监视下,用硬膜外穿刺针引导,穿Ⅱ号普迪丝缝线(PDS-Ⅱ),复位并固定骨折块。结果随访12～24个月(平均18个月)。术前Lyshlom评分30～57分(42.6±2.2),1年后评分96～100分(98.6±2.9),手术前后评分差异有统计学意义(P<0.01)。术后所有患膝活动度恢复正常。结论关节镜下骺板近侧缝线固定治疗儿童胫骨髁间棘骨折具有手术创伤小、术后恢复快、无需二次手术取出内固定等优点,同时避免了损伤骺板可能引起的并发症。

Arthroscopic PDS Fixation of Intercondylar Eminence Fracture Proximal to Epiphysis in Children

Objective To evaluate the effectiveness of arthroscopic PDS fixation of intercondylar eminence fracture proximal to epiphysis in children.Methods Thirty-four children with intercondylar eminence fracture were operated during May 2005 to May 2009,including 23 cases of type Ⅱ and 11 cases of type Ⅲ(Meyers-Mckeever typing).Two epidural needles were inserted toward the intercondylar eminence from the proximum of tibial epiphyseal plate,two PDS introduced into the joint,and the fracture reduced and fixed with the PDS sutures.Results Thirty-four cases were followed up for 12-24 months(average 18 months).Lysholm score was 30-57(42.6±2.2)before operation and 96-100(98.6±2.9)one year after operation with the difference being statistically significant(P<0.01).Conclusion Arthroscopic PDS fixation of intercondylar eminence fracture proximal to epiphysis is an ideal choice of operation for children due to its advantages:minimal invasion,rapid rehabilitation,and no injury to epiphysis.