前交叉韧带胫骨止点撕脱骨折关节镜下骨与周围组织损伤分级及其意义

目的提出前交叉韧带胫骨止点撕脱骨折关节镜下骨与周围组织损伤分级,分析其与Meyers-McKeever分型的一致性,为术前精准评估及治疗方案选择提供指导。方法前交叉韧带胫骨骨性止点及足印为D区,以此为中心,前内侧区域包括内侧半月板前部及膝横韧带内侧部为A区;前外侧区域包括外侧半月板前角及膝横韧带外侧部为B区;后方区域包括外侧半月板后角、内侧半月板后角为C区。关节镜分级:1级为D区不完全损伤,A、B、C区不涉及软组织损伤;2级为D区完全损伤,A、B、C区任意1区或2区存在软组织损伤;3级为D区完全损伤,同时A、B、C区均存在软组织损伤。纳入42例单侧急性前交叉韧带胫骨止点撕脱骨折,4名评估者分别进行关节镜下分级与Meyer-McKeever分型,比较评估者之间一致性。结果评估者对所有患者进行Meyer-McKeever分型与关节镜分级时具有较高的一致性(评估者1的Kappa值为0.804,评估者2的Kappa值为0.809,评估者3的Kappa值为0.808,评估者4的Kappa值为0.712)。结论前交叉韧带胫骨止点撕脱骨折的关节镜分级与Meyer-McKeever分型一样可靠,术前可通过二者的一致性准确预判骨折及其周围组织损伤情况,从而正确指导治疗方案选择。

Grading of anterior cruciate ligament tibia insertion avulsion fractures and surrounding tissue injures under arthroscope and its guiding significance

ObjectiveTo propose the arthroscopic grading of bone and surrounding tissues injures of anterior cruciate ligament tibial avulsion fractures and analyze its consistency with Meyers-Mc Keever classification to provide guidance for accurate preoperative evaluation and treatment options.MethodsThe anterior cruciate ligament tibial bony stop and the foot print were zone D.With this as the center,the anteromedial area included the anterior part of the medial meniscus and the medial knee transverse ligament as zone A;the anterolateral area included the anterior horn of the lateral meniscus and the outer part of the transverse knee ligament as zone B;the posterior area included the posterior corner of the lateral meniscus and the posterior corner of the medial meniscus as zone C.Arthroscopic grading:Grade 1,incomplete damage of zone D,without soft tissue damage in zone A,B,and C;Grade 2,was zone D complete damage,and there was soft tissue damage in any 1 or 2 of zone A,B,and C;Grade 3 it was a complete injury in area D,and there was soft tissue injury in areas A,B,and C.Included 42 cases of unilateral acute anterior cruciate ligament tibial anchorage avulsion fractures,and 4 evaluators underwent arthroscopic classification and Meyer-Mc Keever classification to compare the consistency between evaluators.ResultsThere was a high consistency between the evaluator’s Meyer-McKeever classification and arthroscopic classification for all patients(evaluator 1’s Kappa was 0.804,evaluator 2’s Kappa was 0.809,evaluator 3’s Kappa was 0.808,the Kappa of evaluator 4 was 0.712).ConclusionThe arthroscopic classification of anterior cruciate ligament tibial avulsion fracture is as reliable as the Meyer-Mc Keever classification.The consistency of the two can be used to accurately predict the fracture and surrounding tissue damage before surgery,so as to correctly guide the choice of treatment options.