关节镜下经髌腱入路空心拉力螺钉复位固定治疗胫骨髁间嵴撕脱骨折*

目的探讨在关节镜下经髌腱入路,利用空心拉力螺钉复位固定胫骨髁间嵴撕脱骨折(TEFx)的安全性和有效性。方法选取2014年1月-2015年12月23例TEFx的患者,均在关节镜下经髌腱入路,用空心拉力螺钉复位固定。术前Meyers-McKeever分型:Ⅱ型8例,Ⅲ型10例,Ⅳ型5例;男17例,女6例;年龄16～53岁,平均27.8岁。术前前抽屉试验、Lachman试验均阳性。比较术前术后的视觉模拟评分(VAS)、Lysholm、Tegner和国际膝关节文献委员会(IKDC)评分评价患侧膝关节功能。结果 23例患者均得到随访,随访时间30～40个月,平均36个月。术后即刻X线片示TEFx均复位良好,术后3个月骨折均愈合。无1例感染、关节僵硬、伸直受限、复位丢失及神经血管损伤等并发症。最终随访患侧膝关节活动度均恢复正常,前抽屉试验、Lachman试验均阴性。VAS评分术前(4.8±1.2)分,最终随访为(1.2±0.8)分,术前术后比较,差异有统计学意义(t=18.72,P=0.003);Lysholm评分术前为(50.8±6.2)分,最终随访为(90.8±5.4)分,术前术后比较,差异有统计学意义(t=-42.64,P=0.000);Tegner评分术前为(4.0±1.0)分,最终随访为(5.1±1.2)分,术前术后比较,差异有统计学意义(t=-16.82,P=0.005);IKDC主观评分术前为(52.5±7.4)分,最终随访为(91.5±5.7)分,术前术后比较,差异有统计学意义(t=-40.58,P=0.000)。结论膝关节镜下经髌腱入路空心拉力螺钉内固定治疗TEFx具有微创、操作简捷、固定可靠和恢复快的优点。

Arthroscopic treatment for tibial eminence fracture using cannulated lag screw fixation through transpatellar-tendon portal*

Abstract: Objective To investigate the effectiveness and safety of arthroscopic treatment for tibial eminence fracture (TEFx) using cannulated lag screw fixation through transpatellar-tendon portal. Methods Between January 2014 to December 2015, 23 consecutive cases with TEFx were admitted to our department. All these cases were addressed with cannulated lag screw fixation through transpatellar-tendon portal. All these cases were examined positive Lachman test and anterior draw test. All the affected knees were checked by plain radiograph at postoperative 1st day, 1st month, 3rd month and 6th month. Visual analogue scales (VAS), Lysholm scores, Tegner scores and International Knee Documentation Committee (IKDC) scores were documented at the last follow-up. Results The mean follow-up was 36 months (range 30?~?40 months). Infection, arthrofibrosis, limitation of extension, loss of reduction and neurovascular injury were not found after surgery. All these cases were examined normal range of motion, negative Lachman test and anterior draw test. The reduction of TEFx of all these cases on immdiately postoperative plain radiograph were good. Three months after the operation, the plain radiograph showed that the TEFx of all cases were complete healing. VAS scores was improved from (4.8 ± 1.2) preoperative to (1.2 ± 0.8) at the last follow-up (t = 18.72, P = 0.003). Lysholm scores was improved from (50.8 ± 6.2) preoperative to (90.8 ± 5.4) at the last follow-up (t = -42.64, P = 0.000). Tegner scores was improved from (4.0 ± 1.0) preoperative to (5.1 ± 1.2) at the last follow-up (t = -16.82, P = 0.005). IKDC scores was improved from (52.5 ± 7.4) preoperative to (91.5 ± 5.7) at the last follow-up (t = -40.58, P?=?0.000). Conclusion Arthroscopic treatment for tibial eminence fracture (TEFx) using cannulated lag screw fixation through transpatellar-tendon portal is secure and effective surgical option. This method have much advantages, including: minimal invasive, simple to perform and rapidly rehabilitation.