关节镜下骺板近端三维缝合固定治疗少年胫骨髁间前棘撕脱骨折

目的:探讨关节镜下骺板近端三维缝合固定治疗少年胫骨髁间前棘撕脱骨折的临床疗效。方法:2008年5月~2010年5月,对10例少年胫骨髁间前棘骨折移位患者,在关节镜下行骨折断端清理、复位,C臂机透视下避开骨骺建立胫骨隧道,自制缝针、钩针导引普通丝线于前交叉韧带前1/3、1/2处镜下两次穿越,普通丝线导引钢丝及PDS-Ⅱ线穿越前交叉韧带。固定物在冠状面两次穿越骨隧道-前交叉韧带-骨隧道,骑跨式三维固定撕脱骨块,有效防止撕脱骨块前后旋转、左右摆动和上下浮动。拉紧钢丝及PDS-Ⅱ线,关节外打结固定。术后下肢支具外固定并早期进行功能康复。术后采用Lysholm评分标准评估疗效。结果:全部病例均获随访,随访时间6～36个月,平均18.2个月。X线片示骨折均愈合。患者膝关节无疼痛,前抽屉试验阴性,Lachman试验阴性。术前Lysholm评分(45.8±7.6)分,术后(97.2±9.1)分,手术前后评分差异有统计学意义。结论:关节镜下骺板近端三维缝合固定治疗少年胫骨髁间前棘撕脱骨折创伤小,不损伤骺板,操作简单,疗效可靠。

Arthroscopic Proximal Epiphyseal Plate Three-dimensional Suture Fixation for the Treatment of Juvenile Tibial Anterior Intercondylar Eminence Avulsion Fracture

Objective To discuss the advantages of arthroscopic proximal epiphyseal plate three-dimensional suture fixation for the treatment of juvenile tibial intercondylar eminence avulsion fracture.Methods From May,2008 to May,2010,10 cases of juvenile tibial intercondylar eminence displacement fracture were treated in our hospital.Under arthroscopy,the fracture-end was clear up and replaced,and then tibial tunnel was built with assistance of C-arm machine avoiding epiphysis.Ordinary silk suture was passed through 1/3 in front of ACL,then steel wire and PDS-Ⅱ thread crossed over the ACL twice under the guidance of the silk suture and crochet hook.After tightening the steel wire and PDS-Ⅱ,extra-articular knot was made firmly.External fixation of leg was applied and early rehabilitation was carried out after operation.Lysholm scoring criteria was used for assessment of curative effect.All cases were followed up for an average of 18.2 months(6~36 months).Results The X-ray showed that the fractures healed completely.There was no knee pain.Anterior drawer test and Lachman test were negative,and Lysholm score significantly increased from 45.8±7.6 before operation to 97.2±9.1 after operation.Conclusions Arthroscopic proximal epiphyseal plate three-dimensional suture fixation for the treatment of juvenile tibial intercondylar eminence avulsion fracture reveals less trauma,no harm to epiphyseal plate,easy operation,and reliable effect.