關節鏡下不可吸收縫線聯合微型鋼板固定治療前交叉韌帶脛骨止點撕脫骨折_《中國修復重建外科雜志》

作者：

王穗源 , 肖揚 , 童作明 , 李貴求 , 蔣聚華 , 姚京輝 , 吳志勇 , 李騰飛 , 伍群

南華大學附屬婁底市中心醫院骨科（湖南婁底，417000）;

關鍵詞：

前交叉韌帶，脛骨止點撕脫骨折，關節鏡，不可吸收縫線，微型鋼板

DOI：

10.7507/1002-1892.20130227

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目的探討關節鏡下不可吸收縫線聯合微型鋼板固定治療前交叉韌帶（anterior cruciate ligament，ACL）脛骨止點撕脫骨折的方法及療效。方法2009年1月－2012年3月，收治32例ACL脛骨止點撕脫骨折患者。男18例，女14例；年齡12～40歲，平均17.5歲。致傷原因：交通事故傷15例，運動傷6例，摔傷11例。受傷至手術時間為7～18 d，平均9.5 d。Lachman試驗均為陽性。膝關節Lysholm 評分為（52.13 ± 4.22）分，國際膝關節文獻委員會（IKDC）評分為（44.82 ± 2.44）分。按照Meyers-McKeever分型標準：Ⅱ型12例，Ⅲ型20例。關節鏡輔助下骨折撬撥復位后，采用Ethibond不可吸收縫線繞行呈“八”字形的兩脛骨隧道并掌指骨微型鋼板懸吊固定。結果術后切口均Ⅰ期愈合，無關節感染、皮膚壞死等并發癥發生。患者均獲隨訪，隨訪時間12～50個月，平均22.4個月。術后12周患膝關節Lachman試驗均為陰性。末次隨訪時，3例遺留膝關節伸直受限，其余患者伸膝范圍均正常；屈膝范圍均正常。Lysholm 評分為（94.19 ± 0.93）分，IKDC評分為（94.35 ± 1.22）分，均較術前顯著提高，比較差異有統計學意義（t=55.080，P=0.000；t=101.715，P=0.000）。結論關節鏡下不可吸收縫線聯合微型鋼板固定治療ACL脛骨止點撕脫骨折具有手術創傷小、固定牢固、操作簡便的優點，術后患者膝關節功能恢復良好。

引用本文： 王穗源,肖揚,童作明,李貴求,蔣聚華,姚京輝,吳志勇,李騰飛,伍群. 關節鏡下不可吸收縫線聯合微型鋼板固定治療前交叉韌帶脛骨止點撕脫骨折. 中國修復重建外科雜志, 2013, 27(9): 1041-1044. doi: 10.7507/1002-1892.20130227 復制

1.	Shelbourne KD, Urch SE, Freeman H. Outcomes after arthroscopic excision of the bony prominence in the treatment of tibial spine avulsion fractures. Arthroscopy, 2011, 27(6): 784-791.
2.	Sharma A, Lakshmanan P, Peehal J, et al. An analysis of different types of surgical fixation for avulsion fractures of the anterior tibial spine. Acta Orthop Belg, 2008, 74(1): 90-97.
3.	Meyers MH, McKeever FM. Fracture of the intercondylar eminence of the tibia. J Bone Joint Surg (Am), 1970, 52(8): 1677-1684.
4.	Johnson DL, Durbin TC. Physeal-sparing tibial eminence fracture fixation with a headless compression screw. Orthopedics, 2012, 35(7): 604-608.
5.	Cloclaerts S, Dossche L. Combined arthroscopic techniques in the treatment of non-union of the anterior tibial spine. Acta Orthop Belg, 2011, 77(3): 394-397.
6.	Liljeros K, Werner S, Janarv PM. Arthroscopic fixation of anterior tibial spine fractures with bioabsorbable nails in skeletally immature patients. Am J Sports Med, 2009, 37(5): 923-928.
7.	Bonin N, Jeunet L, Obert L, et al. Adult tibial eminence fracture fixation: arthroscopic procedure using K-wire folded fixation. Knee Surg Sports Traumatol Arthrosc, 2007, 15(7): 857-862.
8.	Huang TW, Hsu KY, Cheng CY, et al. Arthroscopic suture fixation of tibial eminence avulsion fractures. Arthroscopy, 2008, 24(11): 1232-1238.
9.	Mahar AT, Duncan D, Oka R, et al. Biomechanical comparison of four different fixation techniques for pediatric tibial eminence avulsion fractures. J Pediatr Orthop, 2008, 28(2): 159-162.
10.	Su WR, Wang PH, Wang HN, et al. A simple, modified arthroscopic suture fixation of avulsion fracture of the tibial intercondylar eminence in children. J Pediatr Orthop B, 2011, 20(1): 17-21.
11.	Fabricant PD, Osbahr DC, Green DW. Management of a rare complication after screw fixation of a pediatric tibial spine avulsion fracture: a case report with follow-up to skeletal maturity. J Orthop Trauma, 2011, 25(12): e115-e119.
12.	Kocher MS, Saxon HS, Hovis WD, et al. Management and complications of anterior cruciate ligament injuries in skeletally immature patients: survey of the Herodicus Society and The ACL Study Group. J Pediatr Orthop, 2002, 22(4): 452-457.
13.	Eggers AK, Beeker C, Weimann A, et al. Biomechanical evaluation of different fixation methods for tibial eminence fractures. Am J Sports Med, 2007, 35(3): 404-410.
14.	趙金忠, 蔣垚, 沈灝, 等. 關節鏡下8字法縫線固定治療成人脛骨髁間隆突骨折. 中國修復重建外科雜志, 2003, 17(3): 205-208.
15.	Park HJ, Urabe K, Naruse K, et al. Arthroscopic evaluation after surgical repair of intercondylar eminence fractures. Arch Orthop Trauma Surg, 2007, 127(9): 753-757.
16.	Wang J, Ao Y. Analysis of different kinds of cyclops lesions with or without extension loss. Arthroscopy, 2009, 25(6): 626-631.
17.	Kambhampati S, Ware H. Inverted cyclops lesion after anterior cruciate ligament reconstruction. Ann R Coll Surg Engl, 2012, 94(2): e99-100.

1. Shelbourne KD, Urch SE, Freeman H. Outcomes after arthroscopic excision of the bony prominence in the treatment of tibial spine avulsion fractures. Arthroscopy, 2011, 27(6): 784-791.
2. Sharma A, Lakshmanan P, Peehal J, et al. An analysis of different types of surgical fixation for avulsion fractures of the anterior tibial spine. Acta Orthop Belg, 2008, 74(1): 90-97.
3. Meyers MH, McKeever FM. Fracture of the intercondylar eminence of the tibia. J Bone Joint Surg (Am), 1970, 52(8): 1677-1684.
4. Johnson DL, Durbin TC. Physeal-sparing tibial eminence fracture fixation with a headless compression screw. Orthopedics, 2012, 35(7): 604-608.
5. Cloclaerts S, Dossche L. Combined arthroscopic techniques in the treatment of non-union of the anterior tibial spine. Acta Orthop Belg, 2011, 77(3): 394-397.
6. Liljeros K, Werner S, Janarv PM. Arthroscopic fixation of anterior tibial spine fractures with bioabsorbable nails in skeletally immature patients. Am J Sports Med, 2009, 37(5): 923-928.
7. Bonin N, Jeunet L, Obert L, et al. Adult tibial eminence fracture fixation: arthroscopic procedure using K-wire folded fixation. Knee Surg Sports Traumatol Arthrosc, 2007, 15(7): 857-862.
8. Huang TW, Hsu KY, Cheng CY, et al. Arthroscopic suture fixation of tibial eminence avulsion fractures. Arthroscopy, 2008, 24(11): 1232-1238.
9. Mahar AT, Duncan D, Oka R, et al. Biomechanical comparison of four different fixation techniques for pediatric tibial eminence avulsion fractures. J Pediatr Orthop, 2008, 28(2): 159-162.
10. Su WR, Wang PH, Wang HN, et al. A simple, modified arthroscopic suture fixation of avulsion fracture of the tibial intercondylar eminence in children. J Pediatr Orthop B, 2011, 20(1): 17-21.
11. Fabricant PD, Osbahr DC, Green DW. Management of a rare complication after screw fixation of a pediatric tibial spine avulsion fracture: a case report with follow-up to skeletal maturity. J Orthop Trauma, 2011, 25(12): e115-e119.
12. Kocher MS, Saxon HS, Hovis WD, et al. Management and complications of anterior cruciate ligament injuries in skeletally immature patients: survey of the Herodicus Society and The ACL Study Group. J Pediatr Orthop, 2002, 22(4): 452-457.
13. Eggers AK, Beeker C, Weimann A, et al. Biomechanical evaluation of different fixation methods for tibial eminence fractures. Am J Sports Med, 2007, 35(3): 404-410.
14. 趙金忠, 蔣垚, 沈灝, 等. 關節鏡下8字法縫線固定治療成人脛骨髁間隆突骨折. 中國修復重建外科雜志, 2003, 17(3): 205-208.
15. Park HJ, Urabe K, Naruse K, et al. Arthroscopic evaluation after surgical repair of intercondylar eminence fractures. Arch Orthop Trauma Surg, 2007, 127(9): 753-757.
16. Wang J, Ao Y. Analysis of different kinds of cyclops lesions with or without extension loss. Arthroscopy, 2009, 25(6): 626-631.
17. Kambhampati S, Ware H. Inverted cyclops lesion after anterior cruciate ligament reconstruction. Ann R Coll Surg Engl, 2012, 94(2): e99-100.

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關節鏡下不可吸收縫線聯合微型鋼板固定治療前交叉韌帶脛骨止點撕脫骨折

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